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Assistive technology provision: towards an international framework for assuring availability and accessibility of affordable high-quality assistive technology

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Purpose: This is a position paper describing the elements of an international framework for assistive technology provision that could guide the development of policies, systems and service delivery procedures across the world. It describes general requirements, quality criteria and possible approaches that may help to enhance the accessibility of affordable and high quality assistive technology solutions. Materials and methods: The paper is based on the experience of the authors, an analysis of the existing literature and the inputs from many colleagues in the field of assistive technology provision. It includes the results of discussions of an earlier version of the paper during an international conference on the topic in August 2017. Results and conclusion: The paper ends with the recommendation to develop an international standard for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for people with disabilities. The paper outlines some the key elements to be included in a standard. • Implications for Rehabilitation • Assistive technology is a key element in rehabilitation, but many people have no access to affordable AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery procedures on how to improve access to AT across the world.
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Disability and Rehabilitation: Assistive Technology
ISSN: 1748-3107 (Print) 1748-3115 (Online) Journal homepage: http://www.tandfonline.com/loi/iidt20
Assistive technology provision: towards an
international framework for assuring availability
and accessibility of affordable high-quality
assistive technology
Luc de Witte, Emily Steel, Shivani Gupta, Vinicius Delgado Ramos & Uta
Roentgen
To cite this article: Luc de Witte, Emily Steel, Shivani Gupta, Vinicius Delgado Ramos &
Uta Roentgen (2018) Assistive technology provision: towards an international framework for
assuring availability and accessibility of affordable high-quality assistive technology, Disability and
Rehabilitation: Assistive Technology, 13:5, 467-472, DOI: 10.1080/17483107.2018.1470264
To link to this article: https://doi.org/10.1080/17483107.2018.1470264
© 2018 The Author(s). Published by Informa
UK Limited, trading as Taylor & Francis
Group.
Published online: 09 May 2018.
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ORIGINAL RESEARCH
Assistive technology provision: towards an international framework for assuring
availability and accessibility of affordable high-quality assistive technology
Luc de Witte
a
, Emily Steel
b,c
, Shivani Gupta
d
, Vinicius Delgado Ramos
e
and Uta Roentgen
f
a
School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom of Great Britain and Northern Ireland;
b
TC Beirne
School of Law, The University of Queensland, St. Lucia, Australia;
c
School of Health and Wellbeing, The University of Southern Queensland,
Ipswich, Australia;
d
Department of Health Ethics and Society, Maastricht University, Maastricht, the Netherlands;
e
Faculdade de Medicina da
University of S~
ao Paulo, S~
ao Paulo, Brazil;
f
Research Centre Technology in Care, Zuyd University of Applied Sciences, Heerlen, the Netherlands
ABSTRACT
Purpose: This is a position paper describing the elements of an international framework for assistive tech-
nology provision that could guide the development of policies, systems and service delivery procedures
across the world. It describes general requirements, quality criteria and possible approaches that may help
to enhance the accessibility of affordable and high quality assistive technology solutions.
Materials and methods: The paper is based on the experience of the authors, an analysis of the existing
literature and the inputs from many colleagues in the field of assistive technology provision. It includes
the results of discussions of an earlier version of the paper during an international conference on the
topic in August 2017.
Results and conclusion: The paper ends with the recommendation to develop an international standard
for assistive technology provision. Such a standard can have a major impact on the accessibility of AT for
people with disabilities. The paper outlines some the key elements to be included in a standard.
äIMPLICATIONS FOR REHABILITATION
Assistive technology is a key element in rehabilitation, but many people have no access to affordable
AT solutions. The recommendations in the paper aim to inform policies, systems and service delivery
procedures on how to improve access to AT across the world.
ARTICLE HISTORY
Received 5 March 2018
Revised 23 April 2018
Accepted 24 April 2018
KEYWORDS
Assistive technology; service
delivery; quality
criteria; standards
Introduction
Assistive technology (AT) is an umbrella term for products and
related services used by persons with disability to enable and
enhance their inclusion in all domains of participation. AT can be
used by people of all ages and with all types of impairment (loco-
motor, visual, hearing, speech or cognition) and all sorts of limita-
tions in activities, and for short or long periods of time. The
combination of products and strategies to meet an individuals
needs is called an AT solution, and is developed via processes of
assessment, trial and adaptation [1,2]. Some AT solutions are simple
and require low-tech devices, others are very expensive and com-
plex. This variety of user groups and the wide range of assistive prod-
ucts and related services make the provision of AT a complex issue.
This complexity is further increased by the fact that the impact of a
particular AT solution depends largely on the aspirations and indi-
vidual characteristics of the user. There is not one AT solution that
fits all; what works for one user might not work at all for another.
When this complexity is placed in the context of the worldwide
increase in the number of persons with disability [3], and thus,
the number of people who might benefit from AT in their daily
lives, it is obvious that there is a worldwide challenge to develop
policies, provision systems and procedures that assure the avail-
ability and accessibility of affordable high-quality AT for those
who need it. The details of this challenge are different for each
country, but the question is global: how can we assure that as
many people as possible have access to assistive products and
services that optimally support them to participate in society?
This paper outlines the elements of an international framework
for AT provision that could guide the development of policies, sys-
tems and service delivery procedures across the world. It does not
prescribe how AT provision should be organized, but describes
general requirements, quality criteria and possible approaches.
The paper is based on an analysis of existing literature in this
field and a consultation of experts from different countries and
parts of the world. A draft version of the paper was discussed at
the GREAT conference in Geneva (Global Research, Innovation and
Education in Assistive Technology) that took place in August 2017
as part of the World Health Organisations GATE initiative. Inputs
from that discussion were included in this final version.
Assistive technology as a human right
Public AT provision systems have been in place in many countries
for many years, as part of their national or regional healthcare and
welfare systems. With the publication of the United Nations
Convention on the Rights of Persons with Disabilities (CRPD) [4]an
CONTACT Luc de Witte l.p.dewitte@sheffield.ac.uk University of Sheffield, School of Health and Related Research, 217 Portobello, Sheffield, S1 4DP United
Kingdom of Great Britain and Northern Ireland
This article was originally published with errors. This version has been corrected. Please see Corrigendum (http://dx.doi.org/10.1080/17483107.2018.1479367)
ß2018 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License (http://creativecommons.org/licenses/by-nc-nd/4.0/),
which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited, and is not altered, transformed, or built upon in any way.
DISABILITY AND REHABILITATION: ASSISTIVE TECHNOLOGY
2018, VOL. 13, NO. 5, 467472
https://doi.org/10.1080/17483107.2018.1470264
international legal obligation for countries was created.
This convention, among many other things, commits the ratifying
states to enforce appropriate measures to facilitate access to AT sol-
utions for those who need them to improve independence in daily
life and to participate in society on an equal basis with others. The
CRPD has encouraged the development of AT provision systems,
policies and procedures and granted AT the status of a human right.
The CRPD sets standards for ratifying countries to meet while
addressing inclusion of persons with disabilities. It is built on princi-
ples including respect for inherent dignity, individual autonomy
including the freedom to make ones own choices(article 3(a)).
Ratifying states are obliged to ensure and promote the full realiza-
tion of all human rights and fundamental freedoms for all people
with disabilities(article 4(1)), including promoting the availability,
knowledgeanduseofAT(article4(1)(g)andarticle26(3)).
More than 170 countries have ratified the CRPD, indicating a
commitment to give effect to the rights it embodies and be
bound by its guidelines. Ratifying states are obliged to harmonize
their relevant national laws and policies with the CRPD. This
would mean designing laws and policies in such a way that they
ensure access to support services including AT for all persons with
disabilities requiring it. This includes older people and people
with a chronic disease. It is a human right that persons with dis-
abilities have access to assistive technology that is affordable and
matched to their needs, in line with the United Nations Universal
Declaration of Human Rights (UDHR) [5]. In particular, the right for
persons with disabilities to access the freedoms identified in the
UDHR, such as the right to not be subjected to degrading treat-
ment, the right to work, and the right to access education, may
be protected through the provision of AT.
Access to affordable Assistive Technology is a human right, with a
foundation in the United Nations Convention on the Rights of People with
Disabilities.
Elements of assistive technology provision
The term Assistive Technology provisionentails everything that
is needed to assure that a person with disability who might bene-
fit from AT actually obtains it and obtains the most appropriate
AT solution for that individual. A key element is the service deliv-
ery process, that is the process through which an individual goes
to obtain an AT solution that meets his or her needs. For optimal
AT provision, however, many other elements are also essential.
These elements include: good quality AT products have to be
available at affordable prices; people end users and professio-
nals involved have to know that certain solutions exist; there
have to be professional services providing advice and support;
there have to be policies and procedures to decide about eligibil-
ity for certain solutions and funding mechanisms; there has to be
training on use; there have to be follow-up services; and there has
to be an infrastructure for maintenance and repairs; etc. All these
elements can be organized or arranged in different ways, but they
have to be in place for AT provision to be effective.
The following six paragraphs set out basic requirements and
possible approaches for these elements. The first five elements
can be considered pre-conditions, the sixth is the service delivery
process, which is the key process from a user perspective.
Availability of affordable high quality assistive products
and services
Availability of affordable high-quality assistive products is a ser-
ious problem for many people with disabilities. The market for
assistive products is characterized by relatively small companies,
mostly with a national or regional scope. Exceptions are in the
fields of wheelchairs, prosthetics and orthotics, but even here the
numbers of products sold are insufficient to reach economy of
scale to reduce production costs and lower prices. As a result
most assistive products are expensive, sometimes extremely
expensive. The consequence of this is that, even in high-income
countries, many assistive products are only available to those who
can afford to buy them privately, rather than through a public
provision system. For low- and middle-income countries these
assistive products are simply out of reach. Although everyday ubi-
quitous technologies like smartphones and tablet computers are
becoming more easily available and affordable, and these technol-
ogies increasingly offer assistive solutions, the majority of the
existing products are not within reach for the majority of the peo-
ple with disabilities.
An additional problem is that the AT market is not an open
market, in the sense that end users generally have very little
choice. Decisions are made by intermediary bodies like insurance
companies or municipalities, or by donor-driven organizations and
projects, but very rarely the user directly. This creates a market in
which there are clear needs but users without direct purchasing
power. Additionally, procurement of AT products is often out-
sourced to third parties. While bulk procurement of assistive prod-
ucts by governments, insurance companies or other agencies can
reduce time, effort and costs, it increases the distance between
end usersneeds and outcomes and purchasing decisions.
According to a global study quoted in In a WHO and USAID
(United States Agency for International Development) Joint paper
[6] 53% of the countries surveyed in 2005 had not initiated pro-
grams relating to AT provision. In these countries, AT provision
occurred via non-governmental organizations (NGOs), with limited
reach and a narrow scope of assistive products (e.g., wheelchairs
or prosthetics). In a way this fragments the market and masks part
of the needs in society. States should take responsibility for devel-
oping national policies on AT provision, including policies on
manufacturing and trade of assistive products.
With the publication of the Priority Assistive Products List
(APL), the WHO has set a minimum standard for assistive products
that should be available in all countries [7]. Companies should be
strongly encouraged to produce and sell high-quality assistive
products on this list at the lowest possible prices without compro-
mising on quality standards. For some assistive products, this will
require research into new production techniques and supply chain
efficiencies, including local production to shorten the delivery
chain and save costs for transport etc. Such research should be
supported. In countries without production capabilities arrange-
ments for easy trading and import tax wavers should
be considered.
The availability and affordability of assistive products can be strongly
stimulated by challenging companies to produce and sell high quality
products from the WHO Priority Assistive Products List (APL) at affordable
prices, and by stimulating research into new production techniques,
including local production of proven technologies.
States should develop national policies on AT provision, including a policy
on manufacturing and trade of assistive products. Establishing an
international authority that can support states in this area and can exert
pressure on states should be considered.
An important development is that mainstream technologies,
with the smartphone and the tablet computer as most obvious
examples, offer features that allow them to function as assistive
products. This has opened a whole new market of apps and other
digital products developed for specific populations of people with
468 L. DE WITTE ET AL.
disability. Examples include navigation support apps for persons
who are visually impaired, speech operated environmental control
systems that run on a smartphone and augmentative and alterna-
tive communication (AAC) apps. These applications have the
potential to become available to large user groups at very low pri-
ces, although buying mainstream technologies is often not within
reach of people with disability.
The use of mainstream technologies as a generic platform for specific
assistive products and services should be strongly encouraged.
A specific area that deserves attention is that of self-provision.
Very often people develop assistive products themselves with very
simple and cheap means. Such products can be very effective. It
would be worthwhile to disseminate information about such
cheap solutions and to develop guidelines/tips for making them.
This might contribute to a more accessible provision system.
Information systems
To be able to benefit from any AT solution people must know of
its existence. This implies that information systems are key to any
AT provision system. Such information should be available to end
users as well as professionals involved. Effective awareness raising
is challenging, and information provision should be considered as
an on-going dialog rather than a one-off transaction. The number
of assistive products and related services is large (many thou-
sands) and growing exponentially as a result of developments in
technology. The challenge is not only to provide information
about the existence of particular assistive products, but also about
their quality, usability, effectiveness and availability. And prefer-
ably such information is neutral/independent (not influenced by
commercial or other interests) and supported by research evi-
dence that is based on user experiences.
In Europe, there has been a long-term investment in providing
information about assistive products. This has led to the European
Assistive Technology Information Network (EASTIN) search engine,
which connects websites from a number of European countries
and makes the information publically available to end users and
professionals. In the United States of America a similar database
exists: AbleData, and also Australia has such a database: National
Equipment Database. It is a major challenge to keep this informa-
tion updated. Many of the underlying national websites are under
continuous threat of being closed. In most countries such informa-
tion systems are not available. And in some countries, especially
in rural area, the concept of information through a website is still
non-existent. Here, information dissemination needs to be done
through community based channels in print or verbally. States
should take the responsibility for such information systems and
ensure their availability and quality.
It is essential that countries assure that neutral/independent evidence
based information about AT and related services is available for end users
and professionals. The WHO priority assistive products list (APL) provides a
good starting point for developing such national information systems and
the structure of the EASTIN website provides a useful framework to
build upon.
Professional services, advice and support
Information about assistive products is necessary but insufficient
to ensure adequate AT provision. Developing an individual AT
solution (which is the device plus related support and services,
such as training for the user to safely and effectively operate a
given product) requires high level professional knowledge and
skills. Not only knowledge of the available assistive products and
how to use them, but also knowledge and skills to assess the
needs and ambitions of the individual, and about the way AT
interacts with other support or treatment a person may need.
There is no specific discipline trained for this task, except for the
field of prosthetics and orthotics. AT is not frequently enough a
major topic in the training of healthcare professionals, and differ-
ent healthcare professionals have different scope and depth
across assistive products. Occupational therapists probably have
the best basic training to play a role in AT provision and service
delivery, but in many countries, this discipline does not exist or
only in very low numbers. Only some countries offer postgraduate
courses in AT provision, resulting in a serious lack of expertise and
skills available in most countries. Developing training programs
for professionals to work in this field is fundamental to improving
AT provision and service delivery worldwide. Professional organi-
zations like AAATE, RESNA and ARATA can play an important role
in developing such programs.
It is very important to increase the quantity of AT advisors. The
traditional way of training them in formalized education systems
will take many years. Therefore, others approaches to training
should be applied, for example building on the train the trainer
principle in which existing AT advisors are trained to train col-
leagues around them about the principles of AT. Such pyramid
like structure of training may improve awareness and access to AT
and service delivery worldwide, especially in low- and middle-
income countries.
It is essential that training programmes for professionals to work in the
field of AT are developed and become available worldwide. In connection
to this, the development of an accreditation system for AT experts might
be considered. Professionals involved may be healthcare professionals but
also social and community workers and, in settings where these are not
available, non professional people, for example supported by online tools
and information.
If there are professionals with sufficient knowledge and skills, it
is essential that they are able to offer independent advice and
support. In most countries, such independent advice does not
exist. The available professionals are directly linked to and work
on behalf of the commissioning body and sometimes to the
manufacturer of certain assistive products. Ideally people would
have access to independent centres of expertise, where they are
assessed and receive professional advice.
Each country should assure the availability of independent centres of
expertise where people can get high quality advice and support in the
process of obtaining AT. In Italy a good example of a network of such
centres exists. This could serve as a model.
All professionals involved in AT service delivery, including clini-
cians and technicians, should have clearly described roles and
responsibilities and their competencies should be embedded in
international standards of education and training that define core
competencies.
Eligibility and funding mechanisms
Many people with disability who would benefit from AT do not
have the means to pay for it themselves. This is particularly true
in low- and middle-income countries, but also in high-income
countries for expensive and complex products. In most cases,
there will be a need for some kind of financial support. According
to the earlier mentioned WHO&USAID Joint Paper [6] in 2005,
about one-third of the countries surveyed had not allocated finan-
cial resources for developing and providing assistive products or
associated services. In those countries where there is an allocated
budget, the financing policies may vary from covering full cost of
ASSISTIVE TECHNOLOGY PROVISION 469
AT to partial costs of a limited list of assistive products. In some
countries, there is the possibility of having a personal budget or a
voucher system, that give users choice within a specified price
and/or assistive product range.
A key policy issue in relation to funding mechanisms is decid-
ing who is eligible for obtaining AT and determining the range
and extent of funding. This is a very complicated issue. In contrast
to the intentions of the CRPD most countries rely on medical defi-
nitions and diagnostic criteria to determine eligibility [8].
Developing eligibility models that start from a functional perspec-
tive and the individual ambitions and context of a person to par-
ticipate in society is a major challenge to improve AT provision
worldwide. The ICF framework [9] offers a starting point that can
be used to operationalize (parts of) these models, and some inter-
esting instruments have been developed that could play a role in
this (e.g. WHODAS 2.0 [10] and the Impact-s tool [11]), but a gen-
eric decision model does not exist yet. Such a model would help
to distribute available resources in a fair and equitable way to
those who need them most, irrespective of the funding mechan-
ism chosen.
There is a need for generic models to support decision-making on
eligibility of AT devices and services that start from a functional
perspective and the ambitions of the individual to participate in society,
instead of medical criteria. The development of such models should
be stimulated.
Infrastructure for maintenance and repair
Appropriate infrastructures to support the use of AT for persons
with disabilities are required to ensure that products and services
continue to meet the needs of the user. In education, for example,
a voice-output device is of no use to a student with a communi-
cation impairment if it is broken or if the batteries have run out.
This is an all too common scenario for AT users. A structure incor-
porating a schedule for maintenance and a mechanism for repair
of devices is needed to ensure optimal performance for the user.
The use can often play an important role in maintenance and
repair. This should be part of the advice and training on delivery
of an AT device.
At service delivery systems and models
The service delivery process is informed by the national legisla-
tion, existing policies and the elements described in the five previ-
ous paragraphs. In a study analysing AT provision and service
delivery in 16 European countries in 1994, seven essential steps in
AT service delivery were identified. Although organized in very
different ways, these steps could be found in all participating
countries. In 2013, the AAATE published a position paper in which
these same steps were mentioned as still relevant and adequate
[1]. These seven steps are: (1) initiative first contact; (2) assess-
ment evaluation of needs; (3) typology of the AT solution
choosing the appropriate type of AT; (4) selection selecting the
specific device; (5) authorization for financing obtaining funding;
(6) delivery getting the device to the user; (7) management and
follow up continued support [12]. There is recognition that all
seven steps are important to achieve the functional outcome
desired for AT use, but they are not consistently used in prac-
tice [1,3,13,14].
For the development of service delivery processes the seven steps identified
by the AAATE can serve as a structuring framework.
The aim of AT provision is generally to maintain an individuals
functioning and independence and to facilitate participation,
giving less emphasis to remediation of impairments [1517]. Cook
and Polgar [15] give 5 principles that should guide AT provision:
1. The process is person centered and not product of ser-
vice centred;
2. The outcome is enablement of participation in
desired activities;
3. An evidence-informed process is used;
4. AT provision is conducted in an ethical manner;
5. AT services are provided in a sustainable manner.
Although these principles do not give direct clues for service
delivery practice, they are important quality criteria for service
delivery policies and processes.
The aforementioned position paper of the AAATE sets out six
general quality criteria for AT service delivery. These criteria were
developed from a European study, but are also applicable to other
countries and settings. They are:
Accessibility. A service delivery system is accessible when no
one is excluded from the services or in any other way discrimi-
nated against. It is essential that the system is driven by user
needs and that funds are available to remove financial barriers.
People should know that there is a service delivery system, that
assistive products exist, and where to go to access the system. It
should be easy to obtain appropriate AT solutions without
unnecessary delay. Elements of accessibility are the scope of the
system (who is eligible), its simplicity, the availability of informa-
tion to the public, financial barriers and costs for the user,
duration of the process and the complexity of procedures.
Competence. Professionals involved must have the knowledge
and skills needed to properly meet the user needs. Competence is
about the availability of knowledge, skills and experience neces-
sary to serve the client. Elements are the educational level of pro-
fessionals, the possibilities for further education, the use of
protocols and standards, the availability of information and the
possibility to learn from feedback.
Coordination. A service delivery system needs to be coordi-
nated on three levels: within the primary process aroundan
individual client (with often different professionals being
involved), during the various steps in the process for an individual
client, and in relation with other policies and processes regarding
AT or other forms of support for the individual.
Efficiency. A service delivery system is efficient when it is able
to achieve the best AT solution for the highest number of users,
using the available resources in the shortest time and at the low-
est cost. Elements of efficiency are complexity of procedures and
regulations, duration of the process, control of the system over
the process, mechanisms able to control the costs and effective-
ness, and delegation of decision-making power to the appropriate
level of competence.
Flexibility. A service delivery system is flexible when it is able
to respond to different needs of users, when it is able to adopt
new technologies in an easy way and when researchers and
developers get support for their work, coordinate their work,
cooperate and communicate with users, designers, producers and
utilize new technology to meet needs.
User influence. Users should be involved in all aspects of a ser-
vice delivery system and in their own service delivery process.
Lack of user involvement exposes the risk of wrong or ineffective
intervention, abandonment of assistive products provided and
waste of resources. User influence indicators include the presence
and strength of user organizations, the availability of legal protec-
tion of the users rights, the involvement of users at a policy level,
user empowerment during the individual assessment, communica-
tion with the user in the service delivery process and the influ-
ence of the user on decisions in the process.
470 L. DE WITTE ET AL.
The six quality criteria for AT service delivery and the principles described
by Cook & Polgar may serve as building blocks for a quality assurance
framework for AT service delivery.
Effects, costs and economic impact of AT and
related services
It is widely acknowledged that AT can have a dramatic positive
impact on peoples lives. This can be illustrated through a simple
thought-experiment in which one imagines the consequences if
all people who wear spectacles or hearing aids would have to
hand them in. In the scientific literature, however, not much is
known about the impact and cost-effectiveness of AT. Although
there are some studies [18,19], this has been a neglected field for
many years. This is partly due to the fact that AT is not acknowl-
edged as a major separate issue in most healthcare and welfare
systems, but is also due to the complexity of evaluating the
impact of AT. AT is almost always provided alongside other inter-
ventions like treatment, education or other forms of support, mak-
ing it difficult to extract the specific added value of AT. More
importantly, the effects of AT are individual and depend largely
on the ambitions, capabilities and personal context of the user.
This complexity creates a challenge for research into the effects
and costs of AT. Such research is, however, extremely important
to support the development of evidence-guided AT provision sys-
tems. The emphasis should be on evaluating existing AT.
Research into the (societal) impact and costs of AT is essential for the
development of evidence-guided AT provision systems and service delivery
processes. Such research should be strongly stimulated through specific
funding calls and as part of existing research funding streams.
Towards an international standard for AT provision
It is time to develop an AT provision standard. Without a standard
method or tool to connect services and outcomes, there is a lack
of comparable data for AT, leading to problems in assessing the
impacts of current policies and developing new ones.
Development of an internationally relevant, evidence-based infra-
structure for AT services is critical to advancing all aspects of the
global priority research agenda regarding AT. By delineating the
key elements of AT services and how they interact, a process
standard for AT provision would define a standard of practice
with benchmarks to assess quality of services, provide the basis
for educational curriculum and certification, and enable the collec-
tion of data to assess the impact of AT for policy decision making.
Establishment of core quality performance indicators for AT provi-
sion will support efficient and effective services by optimizing
decision-making. How services are provided will be governed by
national legislation, specific regulations and cultural expectations.
There are established processes for developing and appraising
international standards and several authors from different coun-
tries have published proposals to guide the scope and content
[20,21]. Such a standard should be based on interdisciplinary con-
ceptual and process models and adopt a common language.An
AT process standard should assure the user remains central to all
activities, enable interdisciplinary interaction, recognize the value
of considering pre-interventions which may mitigate the AT serv-
ices needed, be applicable to any type or level of disability, and
address the factors which influence user satisfaction with or aban-
donment of AT. A standardized framework for AT service provision
would allow for the insertion of existing and evolving perform-
ance standards at both the individual and organizational level.
It would function as a platform to develop and support further
strategies and resources to improve AT provision worldwide.
The development of an international AT standard could be
achieved in collaboration with the WHO and a recognized stand-
ards regulatory body, in partnership with international AT net-
works and associations like AAATE, RESNA, ARATA and RESJA.
To further drive and support the development of good AT provision
policies, provision systems and service delivery procedures, an international
AT provision standard should be developed.
Acknowledgements
This paper is based on the inputs of many experts in the field of
assistive technology. We are especially grateful for the comments
of the following colleagues on earlier versions of this paper:
Yasmin Garcia Mendez, Mexico; Liem Nguyen, Australia; Peter
Ngomwa, Malawi; Pam Enderby, UK; Rajendra Prasad, India; Dusan
Simsik, Slovakia; Sharmini Constantinescu, Canada; Yvonne
Heerkens, Netherlands; Sam Simpson, UK; Linda Elsaesser, USA;
Dianne Chambers, Australia.
Disclosure statement
The authors declare they have no competing interests.
ORCID
Luc de Witte http://orcid.org/0000-0002-3013-2640
Emily Steel http://orcid.org/0000-0003-4124-3351
Shivani Gupta http://orcid.org/0000-0002-3300-6850
Vinicius Delgado Ramos http://orcid.org/0000-0002-4566-6637
Uta Roentgen http://orcid.org/0000-0002-3580-2332
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472 L. DE WITTE ET AL.
... To address the large and growing unmet need for AT and achieve universal coverage, in 2014 the World Health Organization (WHO) has established the Global Cooperation on Assistive Technology (GATE [3,4]). The primary aim of the GATE initiative is to improve global access to appropriate and affordable AT for people with varying disabilities, diseases, and age-related conditions, through a series of actions involving five interlinked intervention areas: People, Policy, Products, Personnel, and Provision (for further details see [5][6][7][8][9]). ...
Article
Full-text available
Background: Measuring access to assistive technology (AT) has become a global priority. Recently, the World Health Organization (WHO) has developed the rapid assistive technology assessment (rATA), a population-based household survey that measures the use, need, unmet need, and barriers to accessing AT. Objective: The aim of this paper is to report on the translation and adaptation process undertaken to implement the rATA survey in the Italian context. Method: The Translate, Review, Adjudicate, Pretest, and Document (TRAPD) approach was used to translate and adapt the rATA from English to Italian. Eleven independent reviewers and 23 AT users were involved to validate the Italian translation of the rATA and pilot the survey, respectively. Results: The feedback provided by the first users of the rATA indicate that the data collected are reliable and well reflect the state of AT provision in Italy. Conclusion: This study confirmed the applicability of the rATA survey to the Italian context. The Italian version of the rATA can be used to support the government, the health system as well as the civil society to monitor the current state of AT access (and abandonment) in the country.
... Fourth, the technology system used in this study may be viewed as a relatively simple tool that is suitable for participants relying on verbal instructions as well as participants relying on pictorial instructions. The system, moreover, could be improved over time, based on additional participants' data and staff feedback [37][38][39][40]. The fact that the system relies on fairly affordable everyday commercial components can make it accessible to rehabilitation and care contexts. ...
Article
Full-text available
Objectives The study assessed a smartphone-based technology system, which was designed to enable six participants with intellectual disability and sensory impairment to start and carry out functional activities through the use of reminders and verbal or pictorial instructions. Methods The technology system involved a Samsung Galaxy A22 with Android 11 operating system and four Philips Hue indoor motion sensors. Three to five activities were scheduled per day. At the time at which an activity was due, the system provided the participant with a reminder followed by the verbal or pictorial instruction for the initial part of the first response (e.g., “Go to the bathroom and take the dirty towels”). The instruction would be available (repeated) until the participant responded to it and, in so doing, activated a sensor. Sensor activation caused the presentation of the instruction for the second part of the same (first) response (e.g., “Put the towels in the laundry machine”). The same process occurred for each of the responses involved in the activity. The system was introduced according to nonconcurrent multiple baseline designs across participants. Results During baseline, the mean percentage of activities the participants started independently was below 7; the mean frequency of correct responses per activity was below 0.5 (out of a maximum possible of 8). During the intervention (i.e., with the support of the technology system), the mean percentage and mean frequency values increased to nearly 100 and 8, respectively. Conclusions The data suggest that the aforementioned technology system may enable people with intellectual disability and sensory impairment to start and carry out functional activities independent of staff.
... NcNicholl et al., (2019) in a systematic review of AT use for students with disabilities in higher education identified four analytical themes: AT as a facilitator of academic engagement; barriers to effective AT use can hinder academic participation; the transformative possibilities of AT from a psychological perspective; and AT as a facilitator of participation. In this regard, other studies conclude that the potential use of AT for students with disabilities will promote inclusion and decrease stigma (De Witte et al., 2018;Asongu et al., 2019). ...
Article
The commitment to increase the inclusion of students with disabilities has ensured that the concept of Assistive Technology (AT) has become increasingly widespread in education. The main objective of this paper focuses on conducting a systematic review of studies regarding the impact of Assistive Technology for the inclusion of students with disabilities. In order to achieve the above, a review of relevant empirical studies published between 2009 and 2020 in four databases (Web of Science (WoS), Scopus, ERIC and PsycINFO) was carried out. The sample consists of 31 articles that met the inclusion criteria of this review, out of a total of 216 identified. Findings of this study include that the use of Assistive Technologies is successful in increasing the inclusion and accessibility of students with disabilities, although barriers such as teacher education, lack of information or accessibility are found.
Article
Purpose: The objectives were: (1) to translate and adapt the International Society of Wheelchair Professional (ISWP) basic Wheelchair Service Provision Test (bWSPT) into French-Canadian and (2) to conduct a preliminary evaluation of the French-Canadian version of the ISWP bWSPT internal consistency and relations with other variables among French-Canadian occupational therapy students. Methods: For Phase 1, based on the International Test Commission Guidelines for Translating and Adapting Tests, a forward translation and adaptation from English to French-Canadian was conducted by a translation team. For Phase 2, the validity evidence of the French-Canadian bWSPT was evaluated through internal consistency and comparison of bWSPT scores and final grades of a wheelchair-specific course with a sample of occupational therapy students (positive, moderate correlation hypothesized). Internal consistency was measured with Cronbach's α. The correlation was calculated using the Spearman's Rank Correlation Coefficient. Results: For phase 1, 61 of 167 items of the forward adaptation were revised and modified. All revisions were a consensus by the translation team. For phase 2, we found a Cronbach's α of 0.50 and a correlation of ⍴ = 0.27 (p = 0.43) between the bWSPT French-Canadian version and the wheelchair-specific course final grade. The low variability of the data may explain the lower-than-expected correlation. Other possible data-driven reasons have been explored using post-hoc analysis. Conclusion: The ISWP bWSPT, French-Canadian version, is not internally consistent and demonstrates a non-statistically significant, positive, weak correlation with the final grade of a wheelchair service provision-specific course among a cohort of 35 occupational therapy students.IMPLICATIONS FOR REHABILITATIONThe lack of adequately educated wheelchair service providers is a contributing factor to inappropriate wheelchair provision worldwide.The ISWP Wheelchair Service Provision Basic Test (ISWP bWSPT) has been created to evaluate competency among wheelchair service providers and provides a standardized test recognized internationally.A French-Canadian version of the ISWP bWSPT allows competency testing of French-speaking wheelchair service providers across Canada.This study shows that the French-Canadian version of the test is not internally consistent and has a low correlation with a wheelchair provision-specific course among a cohort of 35 occupational therapy students at a French-Canadian university suggesting further refinement is required to improve its measurement properties in this population of test-takers.
Article
Purpose-This article examines the opportunities to create optimal conditions for individuals with autism, to work successfully within the contemporary workplace and improve their well-being. These opportunities arise from digital technology (DT) development, enabling the work environment to be remodeled by providing new possibilities and ways of working. The author discusses both technology-based as well as non-technological accommodations supporting overcoming the workplace challenges faced by employees with autism. Design/methodology/approach-A qualitative research was conducted with the use of in-depth interviews with 21 individuals with expertise in the field. Findings-Possible technology-based work environment modifications and non-technological managerial practices facilitating work integration and the long-term well-being of individuals with autism were proposed. These solutions address four main problems: 1) effective communication; 2) time management, task prioritizing, and organization of work; 3) stress management and emotion control; and 4) sensory sensitivity. Practical implications-Proposed solutions include primarily the wide usage of electronic mediated forms of communicating based on non-direct and non-verbal contact; a flexible approach towards work organization; accurate stress monitoring systems; and an individualized approach toward office space arrangements limiting external stimuli. Originality/value-All this could lead not only to an increase in employment in individuals on the autism spectrum but also influence the improvement of the job performance of already employed. Modifications introduced could improve the long-term well-being of all employees, both with autism and neurotypical ones.
Thesis
A disszertáció célja annak körüljárása, hogy miként jellemezhető a társadalombiztosítási rendszeren keresztül támogatott gyógyászati segédeszközök hozzáférhetősége Magyarországon, a felhasználók választási szabadsága szempontjából. A feltáró elemzés elméleti kerete az Amartya Sen nevéhez kötődő képességszemlélet (Capability Approach), a jóllét és a fejlődés normatív elmélete, ami a fejlődést az emberek képességeinek és arra való tényleges lehetőségeinek – szabadságainak – bővülésében látja, hogy olyan életet éljenek, amilyet okkal tartanak értékesnek. A segédeszköz elosztást amentén vizsgáltam, hogy az mennyiben személyre szabott, és mennyiben bővíti a felhasználók tényleges lehetőségeit a számukra értékesnek tartott, jó életre: a segédeszközhöz jutás folyamatában mennyiben jelennek meg az érintettek véleményei, értékei, hangja, a „semmit rólunk nélkülünk” elv, milyen garanciákat vállal a jogalkotó és a folyamatban résztvevő többi szereplő annak érdekében, hogy az érintettek tudatában legyenek a valódi választási lehetőségeiknek. A kutatás során – szociálpolitikai alapelveken, nemzetközi tapasztalatokon, három európai tanulmányúton és a képességszemléleten alapulva – elemzési indikátorrendszer készült. A szakirodalom áttekintésén és a jogszabályelemzésen túl, a támogatórendszer gyakorlati működését szakértői és érintetti interjúk (n=52) segítettek feltárni. Magyarországon nincs nemzeti stratégia vagy program, ami bizonyos mértékben biztosítéka volna a támogató technológia hozzáférhetőségének. Több mint ötven jogszabály érinti a gyógyászati segédeszközöket, ezek ugyanakkor kevésbé védik a felhasználókat. A jogalkotó elsődleges célja, hogy megelőzze a túlköltekezést. A gyógyászati segédeszközök mellől elmaradnak a kapcsolódó szolgáltatások, ami nem csak az egyén szintjén teremt problémát, és eredményezi sok esetben az eszközök kihasználatlanságát, hanem csökkenti a gazdaságilag racionális működés valószínűségét is. A támogatott gyógyászati segédeszközök rendszerének jelenlegi működésében az akadályozottság orvosi-medikális modelljének jegyei fedezhetők fel: a szakemberek dominanciája mellett az érintettek valódi részvétele, és valódi választási szabadsága esetleges. Kulcsszavak: Támogató-segítő eszközök és technológia; asszisztív megoldások; képességszemlélet, a fogyatékosság, egészség és jóllét emberi fejlődés modellje
Chapter
Individually adapted and usable assistive technologies are one of the essential prerequisites for empowering people with disabilities. Although a growing number of devices and assistive technologies are available, the proportion of technology abandonment is still very high. This is due to various aspects, which in part lie in the assistive technology itself, in the characteristics of the users or in the psycho-social environment. The diverse contributions in this session show interesting approaches on how to further improve the development, evaluation, and assessment of assistive technologies. The presented results entail important advances in providing people with disabilities with the technology they need in a more suitable and sustainable way.
Chapter
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Research in service robotics strives at having a positive impact on people’s quality of life by the introduction of robotic helpers for everyday activities. From this ambition arises the need of enabling natural communication between robots and ordinary people. For this reason, Human-Robot Interaction (HRI) is an extensively investigated topic, exceeding language-based exchange of information, to include all the relevant facets of communication. Each aspect of communication (e.g. hearing, sight, touch) comes with its own peculiar strengths and limits, thus they are often combined to improve robustness and naturalness. In this contribution, an HRI framework is presented, based on pointing gestures as the preferred interaction strategy. Pointing gestures are selected as they are an innate behavior to direct another attention, and thus could represent a natural way to require a service to a robot. To complement the visual information, the user could be prompted to give voice commands to resolve ambiguities and prevent the execution of unintended actions. The two layers (perceptive and semantic) architecture of the proposed HRI system is described. The perceptive layer is responsible for objects mapping, action detection, and assessment of the indicated direction. Moreover, it has to listen to uses’ voice commands. To avoid privacy issues and not burden the computational resources of the robot, the interaction would be triggered by a wake-word detection system. The semantic layer receives the information processed by the perceptive layer and determines which actions are available for the selected object. The decision is based on object’s characteristics, contextual information and user vocal feedbacks are exploited to resolve ambiguities. A pilot implementation of the semantic layer is detailed, and qualitative results are shown. The preliminary findings on the validity of the proposed system, as well as on the limitations of a purely vision-based approach, are discussed.
Article
BACKGROUND: People with severe/profound intellectual and multiple disabilities often need support for their occupational engagement. OBJECTIVE: This study assessed a smartphone-based intervention program to strengthen a functional object manipulation response (i.e., collecting and putting away objects) and possibly improve the mood of five adult participants with severe/profound intellectual disability and visual-motor impairment. METHODS: The intervention program, which relied on a smartphone linked to a motion sensor, was implemented according to a nonconcurrent multiple baseline across participants design. During the program phase, every object manipulation response (detected by the motion sensor) caused the smartphone to provide the participants with 9 or 10 s of preferred stimulation. Failure to respond for a preset period of time caused the smartphone to present a verbal encouragement/prompt. RESULTS: Data showed that during baseline (prior to the intervention program), the participants’ mean frequency of object manipulation responses per 5-min session was always below three. During the intervention phase, the mean frequency of object manipulation responses varied between about 14.5 and 20.5 per session. Moreover, participants showed mood improvement. CONCLUSIONS: These results suggest that a smartphone-based intervention program may promote functional responding and improve mood in people with severe/profound intellectual and multiple disabilities.
Article
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Purpose: This paper critically reviews and reflects on the processes for providing Assistive Technology (AT) services to Persons with Disabilities (PWD) in Bangladesh, India and Nepal. The aim is to investigate the AT service delivery systems in these countries and suggest improvements where weaknesses are identified. Materials and methods: We carried out a descriptive qualitative exploratory study in Bangladesh, India and Nepal by conducting key informant interviews with policymakers (5), AT service providers (22) and mobility and hearing related AT service users (21). We used a directed content analysis approach guided by a seven-point AT service delivery process model to thematically analyse the existing processes for AT service delivery, from first contact through to follow-up and maintenance. Results: AT service delivery processes are sub-optimal in all three countries, and improvements are needed. No common AT service delivery process was found, although there are common features. In general, it is easier for PWDs in India and Nepal to access AT than for those in Bangladesh, but all three countries are failing to live up to their commitments to uphold the human rights of PWDs. Conclusions: Although good elements of AT service delivery processes can be identified, the systems in all three countries are fragmented and generally weak. A more holistic approach of looking at the process of AT service delivery, from first contact right through to follow-up and device maintenance, with a single door service delivery system, free of cost at the point of service is recommended in these countries. IMPLICATIONS FOR REHABILITATIONAlthough we found significant weaknesses in AT delivery in all three countries, there are some good AT service delivery practices and opportunities for these countries to learn from one another.A systematic and stepwise approach to assessing current AT service delivery processes in the three countries - examining the delivery system as a whole, from initiation to repair and management - can help identify opportunities to improve the process for (prospective) AT users.A more coherent single door system of AT service delivery will increase the quality and efficiency of the fragmented AT service delivery practices in Bangladesh, India and Nepal.
Chapter
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Features Proposes an international evidence-based ideal model of the assistive technology assessment based on experimental research and experiences in assistive products service delivery Brings together in one handbook all the assessment tools needed in an assistive technology service delivery center Describes the professional profiles, skills, and interactions of the multidisciplinary and integrated team members involved in the assessment process Identifies the needed role of professionals of psychotechnology and assessment Reviews all forms of technologies, including recent technologies such as brain–computer interfaces, robotics, and exoskeletons Comes with supplemental material containing the Matching Person and Technology tools in multiple languages. Summary Assistive Technology Assessment Handbook, Second Edition, proposes an international ideal model for the assistive technology assessment process, outlining how this model can be applied in practice to re-conceptualize the phases of an assistive technology delivery system according to the biopsychosocial model of disability. The model provides reference guidelines for evidence-based practice, guiding both public and private centers that wish to compare, evaluate, and improve their ability to match a person with the correct technology model. This second edition also offers a contribution to the Global Cooperation on Assistive Technology (GATE) initiative, whose activities are strongly focused on the assistive products service delivery model. Organized into three parts, the handbook: gives readers a toolkit for performing assessments; describes the roles of the assessment team members, among them the new profession of psychotechnologist; and reviews technologies for rehabilitation and independent living, including brain–computer interfaces, exoskeletons, and technologies for music therapy. Edited by Stefano Federici and Marcia J. Scherer, this cross-cultural handbook includes contributions from leading experts across five continents, offering a framework for future practice and research.
Article
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http://atlasofscience.org/how-much-does-abandonment-of-assistive-technology-cost-italys-national-health-service/
Article
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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.
Article
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BACKGROUND: The Assistive Technology Service Method (ATSM) is an innovative evidence-based process standard to support the provision of person centered, evidence-based, and interdisciplinary assistive technology services. OBJECTIVE: This paper defines challenges with adoption of innovative practices and discusses strategies to diffuse the ATSM for training, education, and gathering knowledge. METHOD: Important central components for the diffusion of innovations are reviewed to include strategies for transferring the evidence into practice and other outcomes of the process. RESULTS: This paper discusses key issues and challenges to professional practice for assistive technology services, presents data on the current state of practice, and delivers strategies to promote innovative interventions and techniques. CONCLUSION: Strategies to implement the adoption of an interdisciplinary service delivery method must consider provider knowledge and awareness of need with development of tools for effective use of the innovation.
Article
Full-text available
The purpose of the present work is to present some aspects of the Assistive Technology Assessment (ATA) process model [1] compatible with the Position Paper 2012 by AAATE/EASTIN [2]. Three aspects of the ATA process will be discussed in light of three topics of the Position Paper 2012: (i) The dimensions and the measures of the User eXperience (UX) evaluation modelled in the ATA process as a way to verify the efficient and the evidence-based practices of an AT service delivery centre; (ii) The relevance of the presence of the psychologist in the multidisciplinary team of an AT service delivery centre as necessary for a complete person-centred assistive solution empowering users to make their own choices; (iii) The new profession of the psychotechnologist, who explores user’s needs by seeking a proper assistive solution, leading the multidisciplinary team to observe critical issues and problems. Through the foundation of the Position Paper 2012, the 1995 HEART study, the Matching Person and Technology model, the ICF framework, and the pillars of the ATA process, this paper sets forth a concept and approach that emphasise the personal factors of the individual consumer and UX as key to positively impacting a successful outcome and AT solution.
Article
Full-text available
PURPOSE. This article develops a standardised method for assistive technology service (ATS) provision and a logical basis for research to improve health care quality. The method is 'interoperable' across disabilities, disciplines, assistive technology devices and ATSs. BACKGROUND. Absence of a standardised and interoperable method for ATS provision results in ineffective communication between providers, manufacturers, researchers, policy-makers and individuals with disabilities (IWD), a fragmented service delivery system, inefficient resource allocation and sub-optimal outcomes. OBJECTIVES. Synthesise a standardised, interoperable AT service method (ATSM) fully consistent with key guidelines, systems, models and Federal legislation. Express the ATSM using common and unambiguous language. RESULTS. Guidelines, systems, models and Federal legislation relevant to ATS provision are reviewed. These include the RESNA Guidelines for Knowledge and Skills for Provision of Assistive Technology Products and Services (RESNA Guidelines), IMPACT2 model, international classification of functioning, disability and health (ICF) and AT device classification (ATDC). Federal legislation includes the Assistive Technology Act of 2004, Americans with Disabilities Act of 2008 and Social Security Act. Based on these findings, the ATSM is synthesised and translated into common and accessible language. CONCLUSION. ATSM usage will improve communication between stakeholders, service delivery coherence, resource allocation and intervention outcomes.
Book
It's here: the latest edition of the one text you need to master assistive strategies, make confident clinical decisions, and help improve the quality of life for people with disabilities. Based on the Human Activity Assistive Technology (HAAT) model, Assistive Technologies: Principles and Practice, 4th Edition provides detailed coverage of the broad range of devices, services, and practices that comprise assistive technology, and focuses on the relationship between the human user and the assisted activity within specific contexts. Updated and expanded, this new edition features coverage of new ethical issues, more explicit applications of the HAAT model, and a variety of global issues highlighting technology applications and service delivery in developing countries.
Article
The purpose of this paper is to indicate a framework for exploiting the potential role of assistive technology (AT) in supporting care and participation of people with disabilities and elderly people through appropriate service delivery systems (SDS). The paper is based on the findings of the AAATE/EASTIN workshop Service Delivery Systems on Assistive Technology in Europe (held in Copenhagen on May 21-22, 2012, under the patronage of the Danish EU Presidency), on the roadmaps indicated by the previous HEART Study published in 1995 by the European Commission, and on a consensus process within the Board of the AAATE (Association for Advancement of Assistive Technology in Europe) and the EASTIN Association (European Assistive Technology Information Network). The first chapter Background) discusses the reasons why a position paper on this issue was deemed useful; it also summarises the key themes of the Copenhagen workshop and recalls the HEART Study. The second chapter (The scope of an AT SDS), discusses the concept of assistive solutions-intended as individualised interventions providing users with appropriate environmental facilitators (AT products, personalised environmental modifications, personal assistance) to overcome disability and enable participation in all aspects of life-and the mission of a SDS-ensuring that all people with disabilities can access appropriate assistive solutions that are able to support autonomy in their life environment. The paper also points out that AT service delivery policies should be well coordinated with accessibility policies i.e. those related to infrastructural interventions ensuring that the mainstream environment, products and services are usable by all people, including those with reduced function or who depend on assistive technology. The third chapter (Basic features of an AT SDS) discusses why public SDS are needed for AT, what the main AT SDS models are, and how a SDS process can be described and monitored in terms of quality. The discussion is organised into answers to eight recurring questions: 1) Are assistive technology products going to disappear in the future, due to the embodiment of accessibility features in mainstream products; 2) Why shouldn't assistive technology products be dealt with as common consumer goods, purchased directly by users without the intermediation of service delivery systems; 3) Are there different approaches for AT service delivery; 4) When can a medical model, or a social model, or a consumer model be considered appropriate; 5) Independently of the model and the Country or Region, is it possible to identify common steps in the service delivery process; 6) How does each step influence the costs and the outcomes of the whole process; 7) How can the SDS process be monitored by quality indicators; and 8) How can information support the service delivery process. The last chapter (Some recommendations) provides a number of useful recommendations for those who are engaged in the design, development and implementation of AT SDS policies. The recommendations are clustered round the six SDS quality indicators suggested by the HEART Study: Accessibility, Competence, Coordination, Efficiency, Flexibility, User Influence.
Article
Seventeen years ago the European Commission funded HEART (Line C) project released a report on rehabilitation technology service delivery, describing the processes from 16 countries and making recommendations for improvement by market stimulation and quality assurance. Service delivery of rehabilitation technology, now more commonly referred to as Assistive Technology (AT), has advanced since the 1994 report. Highlights include the establishment of the EASTIN network of AT databases, expansion of systems that facilitate user choice, and a stronger sector identity promoted through the AAATE. Policies and attitudes toward disability have also changed at a societal level over the intervening years, reflected in key documents such as the UN Standard Rules, the ICF, the UN CRPD and the European Disability Strategy 2010-2020. People with disabilities can expect to be provided with information about and access to technologies and services enabling their participation and integration in society. Yet discussion about issues including the ageing population, keeping up with technological advances and containing costs in health and social care budgets, is not new. The message is the same as it was in 1994; we need to work together to meet the challenges. The difference now is that, with progress slower than expected, the voices are more urgent. Aim: This paper reflects the advances in service delivery since the HEART study, the impact of European policy and strategy on development in the AT field, and the current challenges the sector faces. It is intended to stimulate further collaboration and improvements in European AT service delivery. Methods: National contacts from the AAATE were surveyed about the current status of AT service delivery in their respective countries, and asked to comment on the improvements since 1994 as well as the new and continuing challenges and priorities. Survey responses were analysed and recommendations made for further discussion. Results: 13 responses were received, all reporting improvements in elements of AT service delivery, differing in focus across countries. Users frequently have access to AT information but their involvement in decision-making varies. The seven essential steps and six quality criteria for service delivery from the HEART study retain relevance for most respondents, but their use in practice remains limited. The participation of AT practitioners and services in professional development and networking varies from individually organised activities to requisite programmes, and from local to international involvement. Conclusion: European countries have AT service delivery systems that vary in their structure and sophistication, but share some common challenges in meeting the needs of AT service users. Several recommendations are made to inform further discussion and encourage the various stakeholders in AT policy and practice to work collaboratively in improving service delivery across Europe.