Using Assistive Technology Using Assistive Technology with Infants and Toddlers
Pip Campbell/NECTAC/December 2007 ‐‐ Visit our website at tnt.asu.edu
Child & Family Outcomes
•Families are able to support
Federal & State Policy
•Families are able to support their children’s development in natural contexts
•Children are able to Community & Financial Resources
Families & Children
participate in activities that promote growth and learning in natural contexts
•Children’s growth and&Early Intervention •Children s growth and learning opportunities are maximized
AT Use & Practices
Early Intervention Service Providers
Conceptual Model for Understanding AT Use Practices and Early Conceptual Model for Understanding AT Use, Practices, and Early Intervention Outcomes
What is AT?What is AT?
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
Is this AT??Is this AT?? h d • A mother goes to Toys-R-Us and buys a
spoon with a universal handle, a high sided pbowl, and a 2 handled sippy cup
• An SLP brings a Big Mac to a child’s home An SLP brings a Big Mac to a child s home and shows the mother how to program the switch so that it says “come here mommy”switch so that it says come here mommy
• A teacher makes picture cards so that a hild i t t hi h t h t t child can point to which toy he wants to
play with at his child care program Pip Campbell/NECTAC/December 2007 ‐‐
Visit our website at tnt.asu.edu
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
Wh t i AT?What is AT?L T h Hi h T hLow Tech ‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐High TechGeneral; Readily Available Targeted; Specialized General market Small marketGeneral market Small market
Philippa Campbell; TJU, Philadelphia. http://jeffline.jefferson.edu/cfsrp
New Hampshire March 2006 Assistive Technology
What is AT?Technology Related Assistance to Individuals with Disabilities
Actd " f d h h
What is AT?
– device as "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities."
i " i th t di tl i t i di id l ith – service as "any service that directly assists an individual with a disability in selection, acquisition or use of an assistive technology device."
di id l i h Di bili i Ed i Individuals with Disabilities Education Act– device is defined as "any item, piece of equipment, or product
system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve the f i l bili i f hild i h di bili " (34CFR§ 300 5)
, , , pfunctional capabilities of a child with a disability." (34CFR§ 300.5). exception to this definition to exclude surgically implanted medical devices.
– service is defined by the IDEA as "any service that directly assists hild ith dis bilit i th s l ti isiti s f a child with a disability in the selection, acquisition, or use of an
assistive technology device." (34CFR§ 300.6).
Definitions of AT “Devices”Definitions of AT DevicesP t C C di t • Part C Coordinators: – limited availability devices (communication devices; switch
interfaces) viewed as AT device by >90%f ) y– off the shelf (readily available) such as computers, battery
toys, not viewed as AT device by < 60%P id• Providers– limited availability devices viewed as high-tech– off the shelf -- not mentioned within categories of high- and off the shelf not mentioned within categories of high and
low tech• Parents
– limited availability devices seldom mentioned– off the shelf-- widely mentioned
AT -- anything introduced into a child’s life or the places where a childspends time that aids a child in accomplishing a task or participating in anactivity or routine.
⇓ Low Tech: items that can generally be purchased in any store andare used by families with their infants and toddlers generally.
⇑ High Tech: switches, communication devices, computer software, --⇑ High Tech: switches, communication devices, computer software, devices generally not readily available, purchased through specialcompanies, and may require a specialist of some type to help you and your child use the device.
What do we know about Decision Making?Decision Making?
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
Decision Making Decision Making
h l • What percent of infants and toddlers are reported to use AT?p
• What percent may need AT to be successful?successful?
• At what point in working with children p gdo providers consider using AT?
• With what types of children is AT • With what types of children is AT considered?
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
• 4% of infants/toddlers nationally have AT listed on ytheir IFSP’s (DOE Report to Congress, 2004) & this number shown little change over the years.
• Approximately 4% of infants & toddlers in the NEILS l d b i i AT isample were reported to be receiving AT services
% f d l d b l d h ll h ld • 18.1% of providers sampled believed that all children on their caseloads who needed AT were receiving it; 15 7% reported that none of the children who needed 15.7% reported that none of the children who needed AT were receiving it.
Myths about AT Myths about AT n = 967 EI & 924 Parents
• AT requires extra effort of a child and is much easier to just do q jthings for the child. – (73.7% of parents and 94% of providers disagreed)
• Using AT means giving up on doing things the natural way and • Using AT means giving up on doing things the natural way and may prevent the child from learning certain things– (77.6% of parents and 96.4% of providers disagreed)
• AT cost a lot of money and it is a good idea to wait until the child is older to decide what will work– (78% of parents and 92 9% of providers disagreed)(78% of parents and 92.9% of providers disagreed)
• Young children need to have certain skills, like using their hands or being able to recognize symbols, before they can use assistive t h l technology. – (44.6% of parents and 73.9% of providers disagreed)
Dec‐05
Decision MakingDecision-MakingP id s’ p t d d isi n m kin b t • Providers reported decision-making about when to use AT generally reflects current views about best practices for infants and views about best practices for infants and toddlers who may need AT
• Families and providers beliefs about AT are d h
pconcordant with one exception – prerequisite skills for AT. This likely reflects a gap between parent and provider decision making between parent and provider decision making processes
• Policy and procedures were not a strong Policy and procedures were not a strong factor that providers would consider in their decision making processes
Parent and Provider Beliefs About AT for Infants and Toddlers (% Agreeing)
Y hild d t h
80
100• Young children need to have
certain skills before they can use AT
ff f
60
80 • AT requires extra effort from a child and it is much easier to just do things for the child i t d
20
40instead
• Using AT means giving up on doing things the natural way
d h hild
0
20
1 2 3 4
and may prevent the child from learning certain things
• AT costs a lot of money and it l h 1 2 3 4
Parents Prov.
is a good idea to wait until the child is older to decide what will work
Provider Decision MakingProvider Decision-MakingVariable Extremely Important Important TotalThe availability of assistive technolgy 53 4% 28 1% 81.5%The availability of assistive technolgy 53.4% 28.1% 81.5%The parent's attitude toward assistive technology
66.5% 24.5% 91.0%
Provider knowledge of assistive technology 40.1% 33.2% 73.3%Technical support for using assistive technology 49.6% 32.8% 82.4%
Availability of funding 51.2% 23.9% 75.1%Opportunity for trial by borrowing 64.3% 24.1% 88.4%Cost of the device 28.7% 29.7% 58.4%R d t i i t i t d 18 4% 21 0% 39 4%Red tape or excessive requirements associated with using assistive technology for infants and toddlers
18.4% 21.0% 39.4%
Provider's previous experience with a specific device
24.5% 32.1% 56.6%deviceAppropriateness of the device for an infant or toddler
91.5% 6.3% 97.8%
Established policies and procedures related to assistive technology
28.6% 28.0% 56.6%
Support of supervisor or colleague 30.0% 27.1% 57.1%
The physical environment where the child will use the device
44.5% 35.9% 80.4%
Providers: Decision-makingg
h l What would you do?…..– Playing with toysy g y– Dressing
Crawling and Walking– Crawling and Walking– Bathing– Vocalizing– Eating and Drinkingg g
Case Example 1: Child can hold but not manipulate toys toys
80
90
Coordinators: Deaf-Blind (n=36)
80
90
National Sample Providers (n=424)
40
50
60
70
80
enta
ge
40
50
60
70
80
cent
age <12mths
12-24mths
0
10
20
30
40
Perc
e
0
10
20
30
Perc
SkillD l t
Low Tech High Tech No Concern
>24mths
0Skill
DevelopmentLow Tech High Tech No Concern
Development
90
State Coordinators (n=31)
50
60
70
80
90
tage
10
20
30
40
Perc
en
0Skill
DevelopmentLow Tech High Tech No Concern
Case Example 2: Child is unable to participate in p p pdressing
National Sample Providers (N=424) Deaf-Blind Coordinators (N = 36)
60
70
80
90
National Sample Providers (N=424)
<12mths 60
70
80
90
Deaf Blind Coordinators (N 36)
10
20
30
40
50
Perc
enta
ge 12-24mths>24mths
20
30
40
50
Perc
enta
ge
0
10
Skill Development Low Tech No Concern0
10
Skill Development Low Tech No Concern
State Coordinators (N = 31)
60
70
80
90
ge
10
20
30
40
50
Perc
enta
g
0
10
Skill Development Low Tech No Concern
Case Example 3: Child can not get around by p ycrawling or walking
National Sample Providers (N=424) Deaf-Blind Coordinators (N = 36)
60
70
80
90
National Sample Providers (N=424)
60
70
8090
( )
20
30
40
50
60
Perc
enta
ge
<12mths12-24mths>24mths
1020
30
40
5060
Perc
enta
ge
0
10
SkillDevelopment
Low Tech High Tech No Concern0
10
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
60
70
8090
( )
20
30
40
5060
Perc
enta
ge
0
1020
SkillDevelopment
Low Tech High Tech No Concern
Case Example 4: Child unable to sit up for p pbathing
National Sample Providers (n=424)90
State Coordinators (N = 31)
60
70
80
90
e <12mths 50
60
70
80
90
ge
20
30
40
50
Perc
enta
ge <12mths12-24mths>24mths
10
20
30
40
50
Perc
enta
0
10
SkillDevelopment
Low Tech High Tech No Concern0
10
SkillDevelopment
Low Tech High Tech No Concern
Case Example 5: Child is struggling not talking pand struggling to vocalize
National Sample Providers (n=424)
60
70
80
90
National Sample Providers (n=424)
<12mths 60
70
80
90
Deaf-Blind Coordinators (N = 36)
20
30
40
50
60
Perc
enta
ge
<12mths12-24mths>24mths
20
30
4050
60
Perc
enta
ge
0
10
SkillDevelopment
Low Tech High Tech No Concern0
10
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
70
8090
State Coordinators (N = 31)
20
30
40
5060
Perc
enta
ge
0
1020
SkillDevelopment
Low Tech High Tech No Concern
Case Example 6: Child can not eat or drink pwithout assistance
National Sample Providers (n=424) Deaf-Blind Coordinators (N = 36)
50
60
70
80
90
ge
( )
<12mths12-24mths 50
60
70
80
90
ge
10
20
30
40
50
Perc
enta
g 12-24mths>24mths
10
20
30
40
50
Perc
enta
g
0Skill
DevelopmentLow Tech High Tech No Concern 0
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
70
8090
State Coordinators (N 31)
20
30
40
5060
Perc
enta
ge
0
1020
SkillDevelopment
Low Tech High Tech No Concern
What We Have LearnedAT is d tili d ith i f ts d t ddl s• AT is underutilized with infants and toddlers– Reasons described in the literature as potential reasons for under
use have not been verified in our samples People have differin views about what AT may or may not be• People have differing views about what AT may or may not be– This does not necessarily matter if the focus is on children’s
success in participating in family routines and activitiesAdaptation approach– Adaptation approach
• Providers tend to be more concerned with promoting developmental skill acquisition than with children’s successful participation
This skill focus is apparent from the national surveys as well as – This skill focus is apparent from the national surveys as well as initial results from the implementation study
• Initial reports on the implementation study suggest that AT is more closely associated with participation than developmental skill acquisition closely associated with participation than developmental skill acquisition and a participation approach appears to increase families’ acceptance of AT
• Families report higher use of and success of ATp g
Is AT a viable intervention with children is it’s use a “last resort”?
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
Assistive Technology Is An InterventionAssistive Technology Is An Intervention
Family Assessment: Child/Student Performance
Intervention Decision‐Making Framework
strengths, priorities,
activities, routines
Performance Assessment (e.g.,
developmental, skills‐based, etc.)
Going WellNot Going Well Performs Well
(may be strength)
Area of Deficit or Delay
Do Nothing Source of
Opportunity for g pp yLearning & Practice
Use special therapy activities and FIX through
Embed Specializedtechniques to
remediate deficits
Adaptations, AT, Environmental Interventions
Embed Specialized Strategies for Child
Learning
Campbell, P., Thomas Jefferson University 9‐07
Teach Caregivers
Environment ______________________________R tiRoutine ______________________________Activity __________________________
Areas to Consider
Movement Supports(positioning + mobility)
Interaction with Materials Supports
Communication Supports
Environment: BathroomR ti b tht bRoutine bathtubActivity playing with bath toys
Areas to Consider
Movement SupportsMovement Supports(positioning + mobility)Bath seat with suction feet.
Interaction with Materials SupportsBath toys: foam shapes (stick and reach on sides of tub) and floating ring/, squeeze toys; pool noodle carved for squeeze toys; pool noodle carved for batting. Bath mitt, mounted hoop. Container ring to keep toys in reach.
Communication SupportsLaminated body part symbols + communication symbols (“more”, “all done” “my turn” “look!” I want the ball done , my turn , look! , I want the ball, squeezies”) taped on tub side foam pieces.
M SMovement Supports
• On Back
• On Tummy
MaterialsMaterials
AT Communication SupportsAT Communication Supports
AT is one way of adapting in y p gorder to promote children’s participation and learning participation and learning
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
Facilitating Children’s Participation
l d
Facilitating Children s Participation and Learning
Environmental AccommodationsAdapt Room Set‐UpAdapt/Select Child EquipmentEquipment/Adaptations for Positioning
Adapt ScheduleSelect or Adapt Activityp yAdapt MaterialsAdapt Requirements or InstructionsHave Another Child Help ‐‐Have Another Child Help
Peer Assistance/TutoringCooperative Learning
Have an Individual Child Do Something DifferentHave an Individual Child Do Something DifferentHave an Adult Help a Child Do the ActivityHave an Individual Child Do Something Outside
f h R ( i h Ad l )of the Room (with an Adult)
d Adaptation Hierarchy Level
Suggestions
Adapt Set-Up of E i t
Moving furniture within the home to allow a child to walk with a walker; placing all
f t i l ( h l i Environment unsafe materials (such as cleaning solutions) in a locked cupboard
Adapt/Select “Equipment”
Using boppies and bean bag chairs in a child care program so that children can sit with supportpp
Equipment/Adaptations f P
Obtaining an off-the-shelf toilet chair in which a child can sit comfortably and
f l d h h h ld for Positioning safely; Using a stander so that the child can work with others at the sand table
Adapt h d l
Allow longer times for mealtime so that a h ld h d lf f d ll Schedule child who needs more time to self-feed will
have enough time to complete the meal; Select or Reading a story using props so that children Select or Adapt Activity
Reading a story using props so that children may participate actively while listening; incorporating a variety of riding toys into outside play so that all children can ride outside play so that all children can ride.
Adapt/Select Materials &
Purchasing an off-the-shelf puzzle with knobs so that the child can complete the
Toys p
puzzle independently; attaching a switch to a toy so that the child can play with the toy independentlyindependently
Adapt Requirements
Allowing a child to self-feed for the beginning of the meal and then feeding the hild f th i d R d 2 h t or
Instructionschild for the remainder; Read 2 very short stories and require a child who has difficulty attending to attend for one story only.
Using Adaptations & Assistive Technology to Promote Children’s Participation & LearningHere’s the Situation --- Try this Adaptation
Activity or Routine:
What is happening now?
Desired Outcome
Step
Adapt Set Up of Environment
Can use the adaptation/AT without teaching Needs teaching or practice to use AT: Describe:
Adapt Set Up of Environment
Adapt/Select Equipment Needed for Activity
Equipment/Adaptations for Positioning
Communication Socialization/Interaction
Using Hands & Arms
Getting Around (Mobility)( y)
Adapt Schedule
Adapt/Select ActivityAdapt/Select Activity
Adapt Materials/Toys
Philippa Campbell; TJU, Philadelphia. http://jeffline.jefferson.edu/cfsrp
New Hampshire March 2006 Assistive Technology
Adapt Requirements or Instructions
Are these the same??Are these the same??
h ll h • John will point to one of three pictures 100% of the time in order to choose foods during mealtime.
• John will bring the spoon to his mouth • John will bring the spoon to his mouth 80% of the time during mealtimes.
• John will participate in mealtime by selecting foods to eat and feeding selecting foods to eat and feeding himself independently.
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
Eric will participate in transitions in his h l b idi hi bik preschool program by riding his bike.
Keelie will play with her older sister before dinner by selecting toys & using her switch to dinner by selecting toys & using her switch to
turn them on.
Choose food or drinkSelect food
from 4 choices U i U i U i Mealtimes
Arrival,
from 4 choices
Select drink --2 choices
Use voice output to ask
for more
Use voice output for
morning greeting;
Use voice output to ask
for more
Toileting
Opening, & Leaving
greeting; leaving
goodbye to children &
d ltg
Communicate with home‐made 2 or 4
picture
adults
Select pcommunication cards or switch voice output
Use voice output – need
to use bathroom
outdoor play area from 4
choices
Toy Play‐Free Time
Playground
bathroom
U i Select play area from 4
Select Materials
d d
Select toy f 4 h i
Use voice output to ask another child
to play
area from 4 choices
Needed –e.g., for sandbox
Use voice output to ask another child
to play from 4 choices to play to play
What factors influence W at fa t r nf u n successful implementation of
AT Practices?
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
State Profiles ~ Document AnalysisState Profiles Document Analysis• Part C survey ~ and request for documents
– Part C follow upNov 02
Part C follow up– Documents received and initial review
• Web search of all Part C web sites • NATRI school age policy document analysis review/collaboration• NATRI school age policy document analysis review/collaboration• Second Part C follow-up • Second Web search of all Part C web sites
NECTAC web site search• NECTAC web site search• PACER center CD search• Evidence based literature review
Addi i l ll i f i i d ( b h / h )• Additional collection of training documents (web searches/phone)• University Centers on Disability web search (relevant contacts were
made to retrieve documents)J 05Jan 05
Sate Profiles example analysis Composite
SP
s ds t e or
or
score ~ “Top Ten” (0‐11)Max = 18
ogra
phic
Reg
ion
Stat
e
ad A
genc
y C
ode
rt u
se o
f AT
on IF
SR
epor
t to
Con
gres
s(0
- 16
.55)
ents
on
tria
l per
iod
men
ts o
n pa
ymen
t
l Len
ding
Lib
rary
av
aila
ble
rshi
p m
aint
inan
c ere
pair
docu
men
ts
happ
ens
to u
sed
vice
s/eq
uipm
ent
ents
re: t
rain
ing
fopr
ovid
ers
ents
re: t
rain
ing
fopa
rent
s
peci
fic P
olic
ies
Gui
delin
es
umbe
r of T
ools
en Im
plem
enta
tion
an fo
r AT
(IFSP
)
TOTAL SCORE
Geo Lea
%re
por
2002
R
Doc
ume
Doc
um
Loca
Ow
nean
d r
Wha
t de
v
Doc
um
Doc
um S p Nu
Writ
te pla
West Montana Health/Public Health 16.55 1 7Midwest Kansas Health/Public Health 13.88 2 5South Florida Health/Public Health 13.27 0 2South Georgia Human Services/Resources 12.23 3 10South District of Columbia Human Services/Resources 12.14 0 0Midwest Missouri Education 11.98 6 11West Washington Health/Public Health 10.59 0 2Midwest Indiana Other 10.33 3 10South Kentucky Health/Public Health 10.11 1 5Midwest North Dako Human Services/Resources 9.37 0 3
16.55% to 9.37%
Promoting the use of ATPromoting the use of ATHow can the data from this analysis assist states to
id i l d i & i f i f dprovide optimal AT devices & services for infants and toddlers?
• Actual implementation & use of AT devices ANDservices with infants and toddlers nationally is probably between 4% and 22% (based on data from probably between 4% and 22% (based on data from multiple sources) indicating that children who need devices may not be getting themdevices may not be getting them.
• There are no conclusive relationships between state practices (as reflected through documents) and the p ( g )rates of reporting AT on the IFSP (as reported through the Child Count data to OSEP)
What we foundWhat we found…
General trainer/organization information~ website print‐outs, phone/email communication, no materials
Informational booklets~ reference materials that individuals can use through self‐study
Handouts ~ handouts associated with workshops/presentations
Assessment tools~ tools for parents/providers to determine AT needs
lTraining curriculum~ training presentation package
What Providers Told Us (N 450)What Providers Told Us… (N = 450)
k h Tech Fairs/ExposWorkshops
72% attended ‐‐‐‐ 48% V. Helpful
M 19 4 h ( d 28 1 h )
Tech Fairs/Expos
16% attended ‐‐‐‐ 43% V. Helpful
M = 12 7 hours (s d 13 2 hrs)M = 19.4 hours (s.d. 28.1 hrs)
College Course
M = 12.7 hours (s.d. 13.2 hrs)
Video CD Manual Self Study
13% attended ‐‐‐‐ 71% V. Helpful
M = 15 c.h. (s.d. 25.8 c.h.)
Video, CD, Manual Self Study
39% attended ‐‐‐‐ 57% V. Helpful
M = 18.9 hours (s.d. 32.4 hrs)
Internet Self‐Study Mentoring (formal)
8 9 ou s (s d 3 s)
33% attended ‐‐‐‐ 37% V. Helpful
M = 24 hours (s.d. 48.9 hrs)
11% attended ‐‐‐‐ 67% V. Helpful
M = 47.5 hours (s.d. 93.4 hrs)
TrainingTraining
90100
National Sample Providers (N = 424)
90100
State Coordinators (N = 31)
50607080
AttendedVery Helpful 50
607080
1020304050 Very Helpful
20304050
010
Workshops
CourseInternet
Self-Study
Formal Mentorin
Informal Mentori
Fairs/Expos
010
Workshops
CourseInternet
Self-Study
Formal Mento
Informal Ment
Fairs/Exposoringtoring
s y ntoringentoring
s
In SummaryIn Summary…There is a clear need for increased number of trainings and
Policy and Resources
There is a clear need for increased number of trainings and reference materials which focus on AT for the infant/toddler population.
Most trainings found were focused on general transference of knowledge about AT, and limited trainings focused on improving parents or providers’ use of AT in the context of
Training/TA
p g p pservice delivery.
Providers reported little variability in the types of training accessed Pro iders most freq entl reported attending a g/
Practicesaccessed. Providers most frequently reported attending a workshop/presentation.
Clearly, parents and providers need more opportunities to gain knowledge about AT, such as the development of trainings and training materials which focus on best practices of AT use with infants and toddlers.
Some Good Resources Some Good Resources
h //• Great Ideas – http://tnt.asu.edu
• Let’s Play – http://letsplay/buffalo.edu
• Fisher Price Toys - http://www fisher-Fisher Price Toys http://www.fisherprice.com/US/special_needs
Pip Campbell/NECTAC/December 2007 ‐‐Visit our website at tnt.asu.edu
F l ith t di biliti For people without disabilities, technology makes things easier. gy m g .
For people with disabilities For people with disabilities, technology makes things gy g
possible.
Visit our website at http://[email protected]