Access and use of assistive technology for adults living in … · 2020-06-13 · 3 Access and use...

Access and use of assistive technology for adults living in supported accommodation

AUGUST 2011

I n d e p e n d e n t L i v i n g C e n t r e o f W A

T h e N i c h e 1 1 a A b e r d a r e R o a d

N e d l a n d s 6 0 0 9 W e s t e r n A u s t r a l i a

( 0 8 ) 9 3 8 1 0 6 0 0

w w w . i l c . c o m . a u

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ACKNOWLEDGEMENTS

The project was funded by the Disability Services Commission and conducted by

Evana Jacobson, with support from the following organisations:

Brightwater Care Group

Rocky Bay

The Centre for Cerebral Palsy

MS Society Western Australia

Perth Home Care Services

Transition & Integration Services

DSC Accommodation Services

My Place

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Contents PURPOSE .................................................................................................................. 3

BACKGROUND / INTRODUCTION ........................................................................... 3

AIMS & OBJECTIVES ................................................................................................ 4

METHOD .................................................................................................................... 4

THE FRAMEWORK ................................................................................................... 6

LITERATURE REVIEW .............................................................................................. 8

RESULTS ................................................................................................................. 14

Demographic ........................................................................................................ 14

Information Communications Technology : Computer & Internet Access ............. 16

Telecommunications : Telephones & Mobiles ...................................................... 19

Augmentative & Alternative Communication ......................................................... 22

Environmental Control Units & Systems ............................................................... 25

Night time Positioning Equipment ......................................................................... 27

CONCLUSIONS ....................................................................................................... 29

LIMITATIONS OF THE AUDIT ................................................................................. 33

RECOMMENDATIONS ............................................................................................ 34

SUMMARY ............................................................................................................... 36

BIBLIOGRAPHY ...................................................................................................... 38

APPENDICES .......................................................................................................... 39

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Access and use of assistive technology for adults living in supported accommodation. PURPOSE This audit is an initiative of the Independent Living Centre of WA (ILC) to audit and develop a snapshot of access to particular types of assistive technology1 (AT) for adults with disabilities who are living in accommodation support settings in the Perth metropolitan area. The audit reviewed the access and use of specific forms of equipment, information communication technologies (ICT), telecommunications, augmentative and alternative communication (AAC), environmental control units (ECU) and night time positioning equipment.

BACKGROUND / INTRODUCTION “Count Me In – Disability Future Directions” In 2010, Disability Services Commission (DSC) published a document “Count Me In – Disability Future Directions” (Disability Services Commission, 2010). Its purpose was to assist consumers, policy makers and stakeholders to work towards creating a new direction for people living in the community with a disability. 13 priority areas were identified as requiring attention by DSC. One of the priority areas identified was “Enabling Information and Technologies”. It was noted that “Rapidly developing information, communication and assistive technologies have the potential to open up a range of opportunities to people with disabilities”. 6 pathways were identified to assist with achieving this priority area. Of relevance to the audit are the following pathways:

Pathway 1 “Ensure that people with disabilities can easily access and afford new developments in assistive technologies and the technical support needed to maintain their effective use.”

Pathway 3 – “Encourage involvement in web-based interest groups and social networking groups as an important way to achieve connection to others.”

Pathway 4 – “Improve the benefits of assistive technology through better matches between individual needs and equipment and by training people in their effective use.”

1 Assistive Technology is a term for any device, system or design, whether acquired commercially or off the shelf,

modified or customised, that allows an individual to perform a task that they would otherwise be unable to do, or increase the ease and safety with which a task can be performed. (Independent Living Centre Australia, 2009)

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This audit may assist DSC, stakeholders, service providers and consumers to:

Identify unmet needs in the areas of AT in accommodation services.

Provide resources and strategies to manage AT in accommodation services. The Independent Living Centre The ILC has provided information and advice about assistive technology, including telecommunications to people with disability and their carers for over 30 years. ILC Tech service has provided information about computer access, AAC, and environmental controls for 20 years. The ILC has a role in informing the sector about unmet needs and trends in assistive technology and opportunities. This audit will assist the ILC to gain a better understanding of the access to and uptake of assistive technology.

AIMS & OBJECTIVES

The aims and objectives of this project are:

Conduct a brief literature review.

Identify what types of AT people are accessing and using across a range of accommodation settings.

Increase the knowledge base of current practice, identify gaps and future demand from an adult consumer perspective for access to and use of AT within the home and community environment setting.

Provide insight into future directions for policy development in the area of AT in accommodation settings.

METHOD A sample of 60 people was established for this audit and interviews took place from October 2010 – February 2011. People met the eligibility criteria for this project if they satisfied all of the following:

They were aged between 18-65 years old.

They were not living in residential care settings receiving Commonwealth funding.

Had a permanent disability or impairment.

Their impairment impacts on their daily abilities which makes them eligible to receive services from a specialist disability service provider.

They possess a disability attributable to an intellectual, cognitive, neurological, psychiatric, sensory or physical impairment or a combination of these attributes.

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This criteria was selected on the basis that it is similar to the criteria used by the Disability Services Commision & Government of Western Australia for eligibility for adult accomodation support funding. (Disability Services Commision & Government of Western Australia, 2010) The audit included people with a wide range of disabilities including:

Physical disability both with and without complex communication needs.

Intellectual disability.

Progressive Neurodegenerative conditions. The people were selected from a range of accommodation support settings in Western Australia including:

People living in group homes.

People living independently in private accommodation settings or with families with high support needs.

People living in cluster accommodation. All people had access to either Accommodation Support Funding (ASF) and/or Alternatives to Employment Funding (ATE). The management of the person‟s DSC funding a range of models, depending on the service provider and person. The way the person‟s funding is managed falls into 3 types of DSC options which are:

Provider Management.

Shared Management with brokerage services.

Self Managed.

(Disability Services Commision, 2005) The recruitment of the people was sourced by the participating organisations. The project coordinator provided each organisation with a contact letter and consent form (Appendix 6, Appendix 7) which was provided to potential people. The services and people were advised that the audit would be targeting specific areas of assistive technology, including ICT, AAC, ECU and night time positioning equipment. The project coordinator contacted the people to arrange a time to complete the interview (45 – 90 mins). The option was provided for interviews to be completed with proxy input or over multiple sessions. This also enabled the interviewer the opportunity to speak with a range of support staff and family to obtain additional information. The interviews were all completed face to face, with one exception.2

2 This was completed over a phone interview with the subject being provided a copy of the

questionnaire in the post to refer to during the interview process.

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THE FRAMEWORK A number of frameworks have been considered in developing and performing this audit. AT Assessment models provide a framework for arranging the AT assessment process. The overall purpose of a model is to guide a researcher in determining what information is accumulated, what components should be measured and what decisions should be made. (Simpson.R., 2008)

The Human Activity Assistive Technology model (Cook,A.M., Polgar,J.M., & Hussey,S.M., 2008) Cook, Polgar and Hussey have argued that assistive technology services must centre on the individual, with the primary consideration being improved performance. To understand the contribution of assistive technology for enhancing performance, they have proposed the Human Activity Assistive Technology (HATT) model.

This model can be used to develop an understanding of the place of assistive technologies in the place of the lives of those with disabilities.

The model looks at the complexities of a human (a person with a disability) performing a given task (an activity) in a particular situation (within a context), especially when the use of assistive technology is part of that context.

The components of this model are:

Activity - This is the process of doing something, and it represents the functional result of human performance. There are three basic performance areas which are daily living, work & productive activities and play & leisure activity. Activities can then be broken down into smaller tasks.

Human - The human is affected by many factors. In order to achieve goals defined by activities, the motor outputs of communication, mobility and manipulation are required. To achieve this the human require motor output skills, sensory input, cognitive processing. Another important factor is the person‟s abilities (a basic trait) and skills (a level of proficiency). While it is possible to assess a person‟s abilities, it can be difficult to predict what level of skill that person will attain because the person will be affected by a range of factors.

Context - Describes where the activity is being performed, and under what conditions. It includes the specifics of the setting such as the physical setting, the social and cultural context and the set of governing rules and constraints.

Assistive Technology – refers to any form of equipment or support used to complete a task.

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In the HAAT model, a therapist begins with a person‟s desire or requirement to perform an activity and also considers the context. If a person does not have the necessary skills to complete the activity AT may be required. The person still requires skills, but they are adapted to meet the individual abilities of the person and matched to the AT system working towards the completion of specific activity.

A simple example of how the HAAT model can be used is as follows:

Activity – being able to make a phone call.

Context – group home accommodation, phone located in a staff office.

Human – person with communication impairment.

AT – locating a phone in a private area, accessible for all people living in the group home, and consider setting up Skype or National Relay Service to support using this phone in the group home.

Matching Person and Technology The theory of Matching Person and Technology (MPT) is a person centered focus during the assessment and selection of AT. The model demonstrates that although a technology may appear perfect for a given need, it may be used inappropriately or even go unused when critical personality preferences have not been considered. The inclusion of psychosocial characteristics or essential environmental support are not considered during the assessment and provision of AT. (ATOMS Project, 2010) (Scherer, M.J., & Craddock, G., 2002) The model assists in the individual being able to identify their AT needs in the wider scheme and how it will impact upon their overall quality of life. The MPT model is applicable to all ages and disability groups which makes it beneficial when completing research with a diverse number of participants. (Scherer, M.J., & Craddock, G., 2002) The model looks to identify the potential for AT abandonment when the consumer‟s preferences, supports or environment don‟t match with the object of the task and the AT provided. (Cook,A.M., Polgar,J.M., & Hussey,S.M., 2008). The value this model provides is the context that equipment is selected from the person‟s perspective and the potential support needs they require to access AT or equipment in general to complete their activity. (Louise-Bender Pape,T.,Kim,J., & Weiner,B., 2002)

http://en.wikipedia.org/wiki/Personality_psychology

http://en.wikipedia.org/wiki/Psychosocial

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LITERATURE REVIEW Definition of Assistive Technology Assistive Technology means any item, piece of equipment or system, whether acquired off the shelf, modified, customised that is used to increase, maintain or improve the functional capabilities of an individual. (Independent Living Centre Australia, 2009) Assistive Technology is a term recognised and classified by the ISO3 and WHO ICF4 classification systems. ISO 9999 is a comprehensive list of assistive products for persons with a disability which incorporates a range of activities of daily living and instrumental activities of daily living. The equipment covered in the product list covers anywhere a person with a disability would need some AT to complete a task (home, school, work or leisure) and throughout their entire lifetime.

Statistical Data of Assistive Technology in Our Community A recent Australian Bureau of Statistics (ABS) Report in the HUIT reported that at the end of December 2010:

There were 10.4 million active internet subscribers in Australia (excluding internet connections through mobile handsets). This represents annual growth of 16.7% and an increase of 9.9% since the end of June 2010.

Digital subscriber line (DSL) continued to be the major technology for connections, accounting for 43% of the total internet connections, followed closely by mobile wireless 40% of total internet connections.

Mobile wireless was the fastest growing internet access technology in actual numbers, increasing from 2.8 million in December 2009 to 4.2 million in December 2010.

There were 8.2 million mobile handset subscribers in Australia. This represents an increase of 21% from June 2010.

(Australian Bureau of Statistics, 2011)

3 ISO – International Organisation for Standardisation.

http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=50982 4 WHO ICF – World Health Organisation International Classification of Functioning, Disability & Health.

http://www.who.int/classifications/icf/en/

http://www.iso.org/iso/iso_catalogue/catalogue_tc/catalogue_detail.htm?csnumber=50982

http://www.who.int/classifications/icf/en/

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For ISPs with more than 1,000 active subscribers. (Australian Bureau of Statistics, 2011)

The ABS Survey of Disability, Ageing and Carers: Summary of Findings, 2009 (Australian Bureau of Statistics, 2009) found the following:

Currently 1 in 5 Australians have a disability.

The majority of these people are living independently in private accommodation in the community (94%).

The remaining 6% of Australians with a disability live in non-private dwellings (hostels and boarding houses) with 4% of them residing in cared accommodation.

People with a profound core activity limiting disability were less likely to access a computer.

The most common place for people with a disability to use a computer was at home.

The reason most people with a disability accessed the internet was for personal or private reasons.

43% of people with a disability did not use a computer over the past 12 months, in that figure, 75% of them had a profound limiting disability.

47.4% of people with a disability did not use the internet over the past 12 months.

52.6 % of people with a disability were using the internet, 47.8% of which used it at home.

5.3% of people with a disability received assistance with communication.

4.5% of people with a profound disability with have a communication need and in this group 6.5% are living in care accommodation (all age groups).The greatest number of them were in the 45 -60 age group.

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Value of Assistive Technology The literature supports the qualitative belief that the use of assistive technology plays a vital role in enabling people to complete daily activities and participate in community life. (Scherer, M. J., & Glueckauf, R., 2005) The Equipping Inclusion Studies: Assistive Technology Use and Outcomes in Victoria investigated AT looking at what prescribers felt were essential and optimal solutions (without financial restraints) and then they asked the consumers to review and rate these solutions. In many cases, the consumers felt that the “gold standard” exceeded what they actually expected the AT to achieve. A finding from this study is that it was able to decisively validate that AT has a positive impact on a person‟s life and facilitates their daily participation across a broad spectrum of life areas. (Layton, N., Wilson, E., Colgan, S., Moodie, M., & Carter, R., 2010). Another conclusive finding from the same study was that people who have limited or poor access to AT impacted on their ability for community participation and completion of daily activities. (Layton, N., Wilson, E., Colgan, S., Moodie, M., & Carter, R., 2010). The DSC Count Me Document looks to utilise AT as a means of providing people with a disability with increased opportunity for daily participation in community life.

Policy Development Studies highlight the need for policy development for consumers and prescribers of AT. It has been identified that policy should reflect more consumer based control in the selection of equipment by allowing an option for consumers to direct funding for purchase of AT and training for the use of AT. (Hongxin,Z., & Phillips, B., 1993).

Support and Training Needs In 2009 the ILC completed a review of AAC service provision and authored the report “Mapping Best Practice in the provision of AAC” (Moore, 2009). This report contained a literature review of current practices and knowledge of AAC nationally. A key finding was increasing awareness, training and expertise in the sector would support users, families and organisations to manage and use AAC systems more effectively. Another finding was the lengthy period of time people waited to be assessed, trial and receive their AAC systems. Within the sector over 50% of speech pathologist reported having a lack of resources to provide AAC systems for their clients, as they required specialist equipment for trials. An outcome of this report is the pilot of the Streamlining the Process for CAEP Funded Communication Devices Equipment Provision Trial being run through the ILC, which looks at the loan of AAC devices and if the equipment is successful repurchasing a replacement device and allowing the person to keep the trial one.

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In many papers where participants were asked to identify issues relating to use or access to specialist equipment, frequently the lack of support and training for the use of equipment was identified as a barrier (Smith,M.M., & Connolly,I., 2008) (Judge,S., Robertso,Z., & Hawley,M.S., V.5.1 2011). The importance of training has been noted to ensure prescribers, users and support people all have a minimum level of technology awareness (Hongxin,Z., & Phillips, B., 1993) (Scherer,M.J., & Lane,J.P., 1997). In the area of communication and language, as with all areas of assistive technology, the individual‟s needs develop and change throughout their lifetime. New vocabulary regularly enters into mainstream language. A person using AAC requires assistance to update their vocabulary pages and to partner their development of language in a mainstream context. (Smith,M.M., & Connolly,I., 2008)

Use & Abandonment of Assistive Technology In a study by Hongxin & Philips (1993) the researchers were investigating causes for AT abandonment. They identified four factors being a lack of consideration for the user‟s opinion, easy device procurement, poor device performance and change in user needs or priorities. This highlighted the need for AT equipment assessors and providers to consider a more person centred approach to equipment selection, purchase and use of AT. (Hongxin,Z., & Phillips, B., 1993) When assessing and providing AT, the literature states that when the user does not feel the outcome has met their personal goal of achieving the set task this leads to dissatisfaction with the equipment and loss of value. (Scherer,M.J.,Sax,C.,Vandbierdvliet,A.,Cushman,L.A., & Scherer,J.V., 2005) There are many factors that assist prescribers to gain better insight into their user‟s needs and reasons for accepting AT. Having a client centered approach changes how equipment is selected, rather than having a prescriber select AT the user is taking a more active role in identifying and rationalizing their use of equipment in their own context. (Cook,A.M., Polgar,J.M., & Hussey,S.M., 2008) (Layton, N., Wilson, E., Colgan, S., Moodie, M., & Carter, R., 2010). The literature also identifies that a change in the user‟s needs and situation also have a significant impact on AT use or abandonment. The participants reported the need to have their equipment needs reviewed as their lifestyle and activities changed. (Louise-Bender Pape,T.,Kim,J., & Weiner,B., 2002) (Scherer, 1996)

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Assessment and Evaluation Tools of Assistive Technology No single assessment covered the 5 targeted equipment areas of this audit and therefore a decision was made to create a specific questionnaire that would cover all pieces of equipment and relate this back to the purpose of the audit. This resulted in the creation of the Assistive Technology in Accommodation Data Collection (ATADC) questionnaire described below and found in Appendix 1. In addition, the Psychosocial Impact of Assistive Devices Scale5 (PIADS) was used because it is an outcome measure, which takes into account the individual‟s perception of equipment (refer Appendix 2). The Assistive Technology in Accommodation Data Collection ATADC ATADC is a structured interview which looks at capturing information related to the subject using the AT with the 5 equipment areas in relation to the person‟s accommodation setting. ATADC consists of 100 questions:

Some questions are semi structured.

Some questions contain 5 point rating scale.

Some questions having associated links to subsequent questions.

Some questions have subjective rating scales relating to a people perception on using AT or having equipment.

The ATADC guides the interviewer through each of the equipment areas, covering a range of questions relating to:

The person‟s access and usage of equipment.

Type of AT equipment (including provider of AT).

Level of support needs required to use equipment.

Funding sources for the AT and non-AT equipment used.

Further areas of needs of AT the subject required. Psychosocial Impact of Assistive Devices Scale (PIADS): Version 4.2 The PIADS tool measures the outcomes of AT use which identifies levels of overall performance, participation in community or quality of life. (Scherer, M.J., Jutai, J., Fuhrer, M., Demers, L. & DeRuyter, F., 2007) The questions related to self-esteem and competence integrate well with the HAAT model and are considered an appropriate measure for evaluation of individual AT devices. (Layton, N., Wilson, E., Colgan, S., Moodie, M., & Carter, R., 2010)

5 Version 4.2

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The measure has been shown to be useful when assessing AT outcomes research (Mendonca,R., & Lahm, E.A., 2008) (Layton, N., Wilson, E., Colgan, S., Moodie, M., & Carter, R., 2010). The PIADS measure is a series of questions organised into 3 subscales. The assessment can be self-administered and comprises of a 7 point Likert scale which ranges from -3 (maximum negative impact) through to +3 (maximum positive impact). There are 26 quality of life items that relate to the impacted use of AT devices. The measure has been shown to be a reliable and valid measure (Farber,R.S., & DeRosier,R., 2005) (Day, H., Jutai, J,. & Campbell, K.A., 2002). The subscales target specific areas which are:

Competence - measures feelings of competence and usefulness.

Adaptability - signifies a willingness to try new things.

Self-esteem - indicates feelings of emotional wellbeing and happiness.

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RESULTS Even with active recruitment and an extension of dates only 58 out of the intended 60 interviews were completed. As a result the statistics have been calculated from the total number of 58 people.

Demographic The group was comprised of 30 (53%) males and 28 (47%) females. All people received some form of DSC funding with:

4% receiving only Alternatives to Employment Funding (ATE).

24% receiving a combination Accommodation Support Funding (ASF) and Alternatives to Employment Funding (ATE).

72% receiving only Accommodation Support Funding (ASF). The breakdown of people living in a range of accommodation was:

43% independent accommodation.

43% cluster accommodation.

14% group home accommodation. The majority of people had their DSC funding managed under the provider management model (84%). (Disability Services Commision & Government of Western Australia, 2010) The people all received some form of support in the accommodation, the majority (62%) had full time care in place, with some family or staff member constantly onsite and accessible. The rest of the people (38%) had partial care plans, where there were periods of the day they were left alone or did not require the access to a carer or support worker at all times. People answered the questionnaire in a variety of ways including through independent answers, proxy answers or assisted answers. This provided those with communication impairments the option to answer the questions with or without AAC or support. The people answered as follows:

74% elected self-answered responses.

17% requiring assistance.

9% having proxy answers supplied (in the person‟s presence).

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Figure 1: Subject by age

Figure 2 : People by disability groups

The people were asked to identify their basic demographic information which included a diagnosis, in some cases clients with a dual diagnosis elected to state they had a mental health issue as their primary disability.

0

5

10

15

20

25

18-24 25-34 35-44 45-54 55-64

10

9

6

4

13

6

2

8

0 2 4 6 8 10 12 14

ABI

CP

Neurological

CVA

Intellectual

Spina Bifida

Spinal Injury

MS

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Information Communications Technology6 : Computer & Internet Access The people in this audit had above the Australian average for access to a computer with the majority of people (79%) able to access a computer at home; some people had no access at all (21%). However, even with access to a computer only 52% of people elected to use a computer in the home. The location of the computer was also noted during the questionnaire. 47% of people had the computer located in their room or personal area of their house. Over 50% of people had their computer located in either a shared /communal area (28%) or it was located in a staff office area (22%). Only 2 people had no computer in their homes. The people were also asked as to the frequency that they used the computer:

51% used the computers daily.

15% used the computer a couple of times a week.

4% used the computer rarely.

30% having access but never using the computer at all. In the area of AT for assisting computer access, 41% of people had some form of AT with the over 59% not having any form of AT. For the people (28%) who already had computer AT, many reported they wished to have another assessment to improve their access of the computer. For the people using the computer without and AT a significant number of people (72%) requested some assistance to access their computers better. Under a third of people are independent (27%) when it comes to turning on a computer, with the majority of people (73%) requiring some form of assistance to turn on or trouble shoot if the computer broke down.

Figure 3: The types of Assistive Technology devices in place for people using a computer.

6 Information Communications Technology (ICT) is used as a general term for all kinds of technologies which enable users to

create access and manipulate information. ICT is a combination of information technology and communications technology.

0 1 2 3 4 5 6 7

Trackball

Voice Activation Software

Mouthstick/pointer

Onscreen Keyboard + Mouse

Tobii VS Communicator

Headmouse

Cherry Keyboard + Keyguard

Big Keys + Keyguard

Larger Monitor

Accessibility Features - large screen set

Toughbook

Switch access

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In terms of internet access, people either paid for this or recieved free internet connection. In some situations they had the option of privately paid and free shared internet connection. Out of the total 46 people that had access to a computer:

22% didn‟t have any internet access.

26% utlised free or shared internet access.

52% people paid for their internet access.

Figure 4: Free internet connection by accommodation setting and Paid internet connection by

accommodation setting.

The people were asked if they used the internet to contact family, friends on business in the past month:

30 people didn‟t use the internet to contact anyone.

6 used the internet to contact between <5 people.

8 used the internet to contact between 6-11 people.

10 people used the internet to contact >12 people.

Figure 5 : Multiple ways in which the people use the computer for at home.

0 2 4 6 8 10 12 14 16 18

PAID Internet Independent

PAID Internet Cluster

PAID Internet Group Home

Free Internet Independent

Free Internet Cluster

Free Internet Group Home

Internet Access

0 5 10 15 20 25 30

Social Networking

Games

Document Management

General Surfing

Reading

Videos/ Movies/ Music

Study

Work

Journal

Shopping

Banking

Skype

Other

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Figure 6 : Level of importance for people using IT at home

Figure 7 : Level of satisfaction for people using IT at home.

Figure 8 : Level of difficulty adjusting to using IT at home.

not important 0%

minimal importance

11%

neutral 14%

very important 3%

extremely important

72%

Level of importance 1(low)-5 (high)point scale

not satisfied 5%

minimal satisfaction

14%

neutral 31%

very satisfied 8%

extremely satisfied

42%

Level of satisfaction 1(low)-5(high) point scale

no difficulty 12%

a little difficulty 27%

neutral 27%

very difficult 15%

extremely difficult

19%

Level of difficulty adjusting 1(high)-5(low) point scale

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Telecommunications7 : Telephones & Mobiles The majority of people (62%) have access to a telephone, a few people(3%) had no phone access, with some people (35%) have shared access to a phone. Most people (45%) use the phone independently, some people (38%) require some assistance to use a telephone with some people (17%) not using a phone at all. The location of the phone in accommodation was also asked:

55% had access to a private phone line, located in their room or used a mobile.

4% had access to a shared or communal phone.

41% were only able to access the phone in a staff office area. Increasing number of people use mobile phones, in this audit 18 out of 58 people had mobile phones:

11 lived in independent accommodation.

5 lived in cluster accommodation.

3 lived in group home accommodation setting. A variety of people required some form of assistance to access a telephone either through the use of AT or physical help. Of the 15 people not using the telephone, 5 did not have a communication impairment while 9 had some form of communication impairment. The question was asked as to how many people called family, friends or business in the past month using a telephone:

15 didn‟t use the phone call anyone.

15 used the phone to call less <5 people.

14 used the phone to call between 6-11 people.

14 used the phone to call >12 people.

7 Telecommunication is the transmission of all forms of information over significant distances to communicate. This refers to communication over long or short distances, especially by electrical means such as by telephone, mobile phones, radio, satellite, television and the internet.

http://en.wikipedia.org/wiki/Transmission_(telecommunications)

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Figure 9: People needing assistance using the phone and whether they had communication impairment

and/or used AAC device.

Figure 10 : The types of Assistive Technology used with telecommunications systems being used by

people in the study.

20%

60%

20% Communication Impairment &using AAC

Communication Impairment &Not using AAC

No Communication Impairmentwith Physical Access Issues

0 1 2 3 4 5 6 7 8 9 10

Telstra Big Button Phone

TS Controller + switch access call connect

Bluetooth / stylus

Speaker phone

Skype

Types of AT Equipment

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Figure 11 : People level of importance of using a telephone at home.

Figure 12 : People level of satisfaction using a telephone at home.

Figure 13: Person’s level of difficulty adjusting to using a telephone.

not important 4% minimal

importance 6%

neutral 6%

very important 7%

extremely important

77%

Level of importance 1(low)-5(high)

not satisfied 4%


19%

neutral 33%

very satisfied 8%

extremely satisfied

36%

Level of satisfaction 1(low)-5(high)

no difficulty 12%


neutral 15%

very difficult 12%

extremely difficult

42%

Level of difficulty adjusting 1(high) - 5(low)

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Augmentative & Alternative Communication8 This section of the results is multilayered; the information takes into account the person‟s use of AAC, whether a person has communication impairment (CI), if assistance was required to answer the questionnaire or if a proxy answer was required. This data also links in with the results for telephone access. People answered the questions in a variety of forms; proxy, assisted with or without AAC. The method in which people answered the questions can also be broken into:

65.5% self-answered.

14% assisted answers.

10.4% having proxy answers supplied. During the interviews 7 people used their AAC systems to answer the entire questionnaire. It was determined that 22 out of the 58 people had some form of communication impairment:

62% of people had no communication impairment and required no AAC.

22% had some communication impairment and used AAC.

16% having communication impairment but no AAC.

Figure 14 : People with a communication impairment and how they answered the questions AAC,

Assisted/Proxy or Independent.

8 Augmentative & Alternative Communication (AAC) refers to any device, system, or method (other than natural speech) that

improves or enhances a person‟s ability to communicate. This includes sign language, letter boards, speech-generating devices, computer software, etc.

0

1

2

3

4

5

6

7

8

9

No AAC + AssistedAnswers

AAC + IndependentAnswer

AAC + Assisted Answer

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Over half of the people (57%) had previous contact with a Speech Pathologist for either swallow (44%) or communication interventions (53%). Of the people who had seen a speech pathologist for communication only 22% of people had some form of AAC system with the rest not having any system at all. The question was asked as to why people used AAC and frequently they stated it was the only way new people could understand them; often family, friends and carers had learnt to interpret their gestures and partial verbal phrases.

Figure 15: People with a communication impairment and their accommodation setting.

Figure 16 : Type of AAC used by people.

It should also be noted that many of the AAC systems people were using had not been reviewed for some time and would be considered old technology.

18%

55%

27%

People with a communication impairment & their accommodation setting

Independent

Group Home

Cluster

0

1

2

3

4

5

6

toughbook+

boardmakerwith speech

letterboard messagemate

pic commbook

epsomprinter

neo lightwritter

AAC Devices

24

Figure 17 : Level of importance using AAC.

Figure 18 : Level of satisfaction using AAC.

Figure 19 : Level of difficulty adjusting to using AAC.

not important 23%

minimal importance

15%

neutral 8%

very important 8%

extremely important

46%

Level of importance 1(low) -5(high)

not satisfied 15%


54% neutral

8%

very satisfied 0%

extremely satisfied

23%

Level of satisfaction 1(low) -5(high)

no difficulty 0%


neutral 23%

very difficult 8%

extremely difficult

46%

Level of difficulty adjusting 1(high) -5(low)

25

Environmental Control Units & Systems9 There was a 50:50 split of people who have access to some form of ECU at home. Of those who have accesses:

52% lived in a group home.

27% lived in independent accommodation.

21% lived in cluster accommodation. Automatic electric door openers were the most common ECU equipment used, with only one having voice activated remote control for accessing the television. It was recorded how ECU equipment was funded in the person‟s home:

6 people were funded through CAEP.

1 subject was self-funded.

1 subject was funded via a DEG (Disability Equipment Grants – Lottery West).

22 people were funded through their service provider and were already present in the house when they arrived.

Figure 20 : People responses to the question regarding the need for further or any ECU AT equipment at

home.

9 Environmental control units (ECUs) are systems that enable individuals to control various electronic devices in their

environment through a variety of alternative access methods, such as switch or voice access. ECUs can control lights, televisions, telephones, music players, door openers, security systems, and kitchen appliances. (Brainline Organisation)

Has some form of ECU wants more AT, 12

Has NO form of ECU wants

some AT, 5

26

Figure 21 : Level of importance at having ECU at home.

Figure 22: Level of satisfaction at having ECU at home.

Figure 23: Level of difficulty adjusting to using ECU at home.

not important 0% minimal

importance 0%

neutral 4%

very important 0%

extremely important

96%


not satisfied 4%


0% neutral

4%

very satisfied 0%

extremely satisfied

92%

Level of satisfaction 1(low)-5(high)

no difficulty 85%


neutral 11%

very difficult 4% extremely

difficult 0%

Level of difficulty adjusting 1(high) -5(low)

27

Night time Positioning Equipment10

Auditing AT for night time positioning equipment, included hospital beds, symmetri-sleep systems and pressure care. 69% of people had some form of equipment. Most common being electrically adjustable beds some with or without pressure mattresses. The accommodation setting the people lived in with access to equipment was as follows:

18 in independent accommodation.

8 in cluster accommodation.

14 in group home settings.

Figure 24: How people had their night-time positioning equipment funded.

The above graph demonstrates that people fund their electrically adjustable bed through alternative means to CAEP.

10

Night Time Position Equipment includes the following:

Any equipment or materials used as an overlay on existing mattresses or as the mattress on a bed in order to manage the user’s pressure care needs.

An Adjustable Bed which has a hinged or multi-hinged frame that allows movement and placement into one of many different positions. In most cases, the adjustments made include inclining the upper torso and inclining the lower body. Many other common variations include adjusting height of the beds to make it easier for entry into the bed.

1

5

9

24

1

How people funded their Night time AT Equipment

28

Figure 25: Level of importance of having an adjustable bed.

Figure 26: Level of satisfaction having an adjustable bed.

not important 0%

minimal importance

5% neutral

3%

very important 0%

extremely important

92%


not satisfied

0%


0%

neutral 13%

very satisfied 5%

extremely satisfied

82%

Level of satisfation 1(low)-5(high)

29

CONCLUSIONS Information Communications Technology: Computer & Internet Access

Key Points

The people have access to computers and the internet, however just over 50% them actually use it.

Access to a computer in privacy was an issue for some people living in shared accommodation.

People were very interested to use Skype, but needed someone to show them how.

A general observation as to the issue faced by the people could be the location of a computer and the support required was not always available for them to utilise the computer or internet on site. In over 50% of situations a computer was either located in a staff office or a shared dinning or lounge room area. This meant the person needed to ask for access or have their access being observed by staff or other house mates. A similar observation was made that while the 47 % of Australians used the internet to email or chat rooms as a form of communication, 53% of people never used the computer as a form of social contact. In 98% of Australian homes people use the internet for personal use, within that figure and overwhelming 93% used this as means of social contact. (Blaschke,C.M.,Freddolino,P.P., & Mullen,E.E., 2009) With the greater part of societies‟ social interactions and information gathering being done through the computer and internet, it would seem that there is a need for people living in supportive accommodation to be supported in using this type of technology. Additionally limited experience of some carers and their comfort with technology may impede a client‟s access to a computer with or without AT. Staff turnover may also impact on skills and confidence with using computer technology particularly where people had need for customised access options. The cost for setting up internet access within communal settings posed a challenge for service providers. Service providers may need to develop some policy and guidelines for IP access. In many situations the people had used computers at school, but since becoming adult consumers they hadn‟t had any access to service or equipment. In some cases, people had done a couple of computing classes, but no one in their home could support or encourage their interests.

30

Telecommunications: Telephones & Mobiles

Key Points

People in accommodation support settings have less access to telecommunications (either mobile or landline).

Many people were interested in using telecommunications but required modifications and support to be more independent.

People in this study with communication impairment have little or no access to phones.

There were a number of possible factors as to why people did not use the phone in their homes. Firstly the location of the phone in some accommodation settings was in a staff office (41%) or within a communal location (4%). There appears to be an assumption that some people with communication impairments or intellectual disabilities are not able to use a phone. The results demonstrate that some people had never been taught how to use a phone. For the people who answered with assistance or proxy, they were asked if they had used National Relay Service11 as a means of making a phone call. Many were unfamiliar with this service and how it facilitates the use of a phone for people with communication impairment. Many of the people with a form of communication and/or physical disability seemed interested in Skype12 as a way to contact their families. All of the participants that resided in a group homes were aware of a computer on site, and some were able to access this. However, none of them had been shown the option to use Skype as a means of contacting their family and friends. All felt that this would be a very easy way to call their family if someone was able to set this up (no web camera on the computers) and show them how to make a call. A benefit of setting up Skype as an alternative to a standard phone is people with a communication impairment benefit from a face to face option for communication.

11 National Relay Service: Translation service between voice and non-voice telephone users that provides access to the standard telephone service for people with communication impairment. The service relays voice, modem or telephone typewriter communications. 12

Skype is a software application that allows users to make voice calls over the Internet. Calls to other users within the Skype service are free, while calls to both traditional landline telephones and mobile phones can be made for a fee using a debit-based user account system.

31

Augmentative and Alternative Communication

Key Points

Over a third of participants had some form of communication impairment, but less than half had any form of AAC to help people understand their needs.

Need for education and support to ensure prescribed and supplied devices are used.

People in accommodation settings are often having their words „guessed‟ by family or staff in the cases that they had no AAC.

Those with AAC systems used old technology and could benefit from the newer devices available.

There was some cross over with people having AAC or a communication impairment and their use of phones. In many cases, people who had a communication impairment were the ones not using a telephone or even aware that there were options for them to trial. Additionally, people reported that staff and family often guessed what they were saying which is why they elected to use their AAC device minimally. While most people understood what was being said to them, only 30 people felt that people understood them always. Over 11 people reported only having basic needs understood. The proxy responses were interesting depending on who provided the information. Carers often felt there was an understanding on the person‟s behalf but they were unsure how to facilitate a response.

32

Environmental Control Units

Key Points

Access to other environmental controls, i.e. lights, TV etc was rarely addressed for people.

Many people living in group or shared accommodation felt they could always rely on a carer or someone else around to help them or change a channel, thereby reducing their perceived need for ECU.

Many of the people used the door openers as a form of ECU. In one case one subject had been provided with an electric door opener on her main door, but she was unable to open her security screen door and as such had to leave this unlocked. Consequently, there was no way for her to speak to someone through her door safely. Another subject had no way to access a personal alarm system in between the times his carers were not present and being wheelchair bound and unable to drive his chair to a computer to contact someone. Both of these people lived in private accommodation. A couple of people created home-made door opening systems, which allowed them to turn the handle then hold a rope and drive their wheelchairs back to open their front doors. However, there was no way for them to exit the property quickly in an emergency situation. Environmental control is not funded under the CAEP Impress list; the majority of people with any ECU at home were funded through grants or had them already built into their group home environment.

Night-time Positioning Equipment

Key Points

All participants placed a high value, satisfaction and importance on having an electrically adjustable bed, for themselves and their carers.

People have to self-fund electrically adjustable beds because they are unable to receive one through CAEP.

43.2% of equipment requested through the last round of EFL grants at the ILC were hospital beds.

Many people recognised and reported the value of having a hospital bed with or without pressure care. In most cases this form of equipment had the highest value when compared to the other areas with AT intervention. The common issue amongst people who sourced this equipment privately was the cost involved and how difficult it was to get one provided at home. The reported benefits related to an increase in the individual‟s independence and in supporting their carer‟s duties.

33

LIMITATIONS OF THE AUDIT

The project coordinator was unable to randomly select people.

People who received therapy services already received AT interventions for many of the equipment areas audited.

Service providers without direct access to therapy and professional services didn‟t manage to source people; as a result the inclusion of clients with dual sensory loss was significantly low.

A considerably high proportion of people living in group homes came from the single organisation.

11 Agencies were contacted to assist with recruiting people for the audit; only 2 agencies were unable to recruit.

The data recorded using the PIADS measure for each piece of AT the subject uses could be further investigated.

There was a good representation of cluster and group homes from several organisations.

Figure 27: Areas of interest for further Assistive Technology at home.

0 5 10 15 20 25 30 35

ILC for AAC

ILC for Computer AT

ILC for Telecommunications

ILC for Nighttime Equipment

ILC for ECU

34

RECOMMENDATIONS

ICT Recommendations:

1. Access to online services for education, work, shopping, socialising and communication would increase people‟s independence in community integration.

2. Consider the location & privacy for people using ICT in a shared accommodation setting.

3. Regular training for staff and family is required for them to gain confidence with using ICT with AT needs.

4. Create policies for people living in shared accommodation who access ICT such as setting internet access and identity or password protection.

5. Assess ICT needs of every person who receives DSC funding by making it a basic assumption that every adult needs access to computer, internet and AT.

6. Educate clients and families on the range of everyday tasks people can access through the internet such as, shopping, banking, and social networks.

7. Review funding policies to ensure consumer have the choice to purchase equipment for ICT and training or support to use them.

Telecommunications Recommendations

1. That access to a telephone and or emergency call system be considered a basic need and linked to safety in community living where people are not provided with 24 hour care.

2. Organisations need to consider the location of the phone in share accommodation settings, making it more accessible for all residents.

3. Provide training programs for service providers, clients and families to encourage all DSC funded clients to use mobile or landline phones.

4. Organisations could consider computer based telecommunications like Skype particularly where individuals rely on non-verbal communication options.

5. Families of people living in accommodation support settings be educated on the use of Skype, National Relay Service or AT for phone use.

6. Access to telecommunications need to be seen as opportunities to enhance social connections and participation.

35

Augmentative & Alternative Communication:

1. To increase access to specialist training for accommodation support workers and families to support AAC users.

2. Increase awareness of telecommunication options for people who use AAC within the sector and accommodation support settings.

3. Develop a stronger culture of AAC use in the sector in particular for adults with complex communication needs via training and role modelling and mentoring.

4. Increase access to therapy and professional services to support the ongoing and dynamic needs of people with complex communication needs.

Environmental Control Unit Recommendations:

1. Dedicated recurrent funding be secured for the provision of environmental controls and this be communicated to the sector.

2. Service providers need to develop policies to increase options for clients to access their environment needs should they want to.

3. Home safety assessment should include how clients are able to safely open their primary door. This includes consideration of security screens, sliding door access and peephole or monitoring of callers.

4. There be ongoing review of an individual‟s ECU needs throughout the continuum of their life.

5. Develop training & education for service providers and health professionals around the area of ECU to assist them with identifying unmet needs for DSC clients.

Night-time Positioning Equipment

1. The CAEP policy and application guidelines could reconsider the criteria for electrically adjustable beds making it easier for consumers to receive funding.

2. Increased access to onsite therapy and professional services to allow for reviews of a client‟s positioning needs.

3. Support the manual handling needs of carers and support staff to assist in recognising potential issues and who they can contact for assistance.

36

SUMMARY Information gathered from this audit and the literature review highlight some common findings and themes.

People who had no direct family (i.e. advocates or public trustees) often chose not to pursue AT options outside of those provided by their organisation or service.

A surprising number of people with some form of communication impairment relied upon others interpreting their words for them. A number of the AAC users had old technology which supports the need for revaluating AT throughout a user‟s lifetime.

In cases where the people and families saw the value in ICT they were willing to spend money to purchase AT or equipment to increase social independence. This is in keeping with the values of many Australian homes who use the internet for social communication.

Many carers aren‟t confident or trained in supporting the individual to use their AT; this was reflected throughout this audit process. In the equipment areas that staff were familiar with (beds, doors etc) people rated their importance as very high and there was a high rating in level of satisfaction and little difficulty adjusting to using the equipment. In the AT areas with more complex equipment (AAC or IT) people rated their importance as very high, but often there was a lower rating in level of satisfaction and difficulty adjusting to using the equipment. This supports the need for ongoing support for the staff and families to help the individual. In the area of telecommunications, with one exception there were no real AT options provided to the people. The majority of people left it up to a carer to dial the phone or call their family for them. While the majority of people identified the phone as a very important tool for social contact, their level of satisfaction was low and difficulty of adjustment was high. Among all of the Instrumental Activities of Daily Living13 performed by older adults in the course of a day, the use of a telephone is rated most important. (Fricke J, & Unsworth, C.A. , 2001)

13

Instrumental Activities of Daily Living refers to the six daily tasks (light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone, and managing money) that enable the patient to live independently in the community. (Also see Activities of Daily Living, or ADL.)" ( (Bookman, A., Harrington, M., Pass, L., & Reisner, E., 2007)

37

Where AT and the subject were successful it appears that a common pattern for the assessment, selection and inclusion of the equipment occurred. Service providers might benefit from the following plan when introducing new AT equipment:

1. Complete a functional assessment – establish the task.

2. Actively involve the user in choosing their equipment – determine skills & attributes of the person.

3. Arrange a trial of equipment.

4. Provide training in using the equipment for the individual and their primary support networks – consider the social and environmental context of the task.

5. Ensure equipment is maintained.

6. Ensure ongoing evaluation and review of equipment, person and task. Social connections in the 21st century centre on Information Communication Technology areas. It would be beneficial for service providers to present their clients with the opportunity for social connectivity through ICT. This provides people who have limited social opportunities the chance to meet on a global stage. Technology and Assistive Technology are providing opportunities for people living with a disability that they may not have had in the past. Everyone has a voice; they just need help finding a way to use it.

38

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Bookman, A., Harrington, M., Pass, L., & Reisner, E. (2007). Family caregiver handbook: Finding elder care resources in Massachusetts. Massachusetts: Massachusetts Institute of Technology.

Brainline Organisation. (n.d.). Assistive Technology Glossary . Retrieved April 1, 2011, from www.brainline.org: http://www.brainline.org/content/2009/11/assistive-technology-glossary_page3.html

Cook,A.M., Polgar,J.M., & Hussey,S.M. (2008). Cook & Hussey's Assistive Technolgies: Principles and Practise 3rd Edition. St.Louis: Mosbey Elsevier.

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Disability Services Commision. (2005). Policy Information Sheet : Shared Management Model. Perth: DSC.

Disability Services Commission. (2010). Count Me In: Disability Future Directions. Perth.

Farber,R.S., & DeRosier,R. (2005). Speech recognition software as an assistive device:A piolt study of user satisfaction adn psychosocial impact. Work, 125-134.

Fricke J, & Unsworth, C.A. . (2001). Time use and the importance of instrumental activities of daily living. . Australian Occupational Therapy Journal, 118- 131.

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Judge,S., Robertso,Z., & Hawley,M.S. (V.5.1 2011). The limitations of speech control: perceptions of provision of speech-driven environmental controls. Journal of Assistive Technologies, 4-11.

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Layton, N., Wilson, E., Colgan, S., Moodie, M., & Carter, R. (2010). Equipping Inclusion Studies: Assitive Technology Use and Outcomes in Victoria. Melbourne: Deakin University.

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APPENDICES 1. Assistive Technology in Accommodation Data Collection (ATADC) 2. Glossary of terms & definitions 3. PIADS Form 4. PIADS Glossary of items 5. PIADS ECU Background Form 6. PIADS VOCA Background Form 7. Recruitment Letter & Consent Form 8. Simplified Recruitment Letter & Consent Form

APPENDIX 1: ATADC Form

Assistive Technology in Accommodation Data Collection

Interview Subject ID Date of Interview Interview completed by Previous contact with ILC Independent Living Centre of WA 11a Aberdare Road The Niche Nedlands 6009 Western Australia Including Supplemental Forms completed;

PIADS Computer / internet access PIADS Telecommunications PIADS ECU

PIADS AAC / VOCA PIADS Night time positioning Equipment PIADS background VOCA (Communication) PIADS background ECU Requires referral to ILC

Information collected in this document has been obtained for research purposes only. All Information shall remain confidential.

ID Question Selection Comments

DEMOGRAPHICS

1 Gender Male Female

2 Age 18 - 24

25 - 35 35 - 44

45 - 54 55 - 65

3 What is your medical

condition? (DSC classification)

Please note the Major diagnosis then tick

additional conditions

Write the condition in the

comments column

Cognitive or learning

Intellectual Disability Autism Spectrum

Neurological

Physical Disability Sensory Disability

Psychiatric or other not included

PHYSICAL

4 ABS Classification Self care, mobility and

communication are defined

as core activities. The ABS defines levels of core

activity restriction as follows:

mild — where a person has no difficulty with self care, mobility or

communication,

but uses aids or equipment; moderate — where a person does not

need assistance, but has difficulty with self

care, mobility or communication;

severe — where a person sometimes needs assistance with self care, mobility

or communication; and

Profound — where a person is unable

to perform self care, mobility and/or communication tasks, or always needs

assistance.

COMMUNICATION

5 When people communicate

with you do you?

Always understand everything that is

said Understand most conversations

Understand simple instructions

Understand only simple key words or signs

Not understand anything at all

6 When you communicate

with others?

Do people who don’t know you

understand you?

Do people who know you understand you?

Do you use a communication device to make your needs known

Your basic needs known (sounds &

signs) Are you not understood at all

TYPE OF ASSISTANCE

7 Do have any assistance at home with your personal

care?

Yes No

Paid Unpaid

Hours


8 Do you have any help with domestic tasks?

Yes No

Paid Unpaid

Hours

9 Who is responsibly for

instructing and directing your carers

Self

Someone else Not Applicable

10 How do you organise their payment of carers or any

changes to their rosters?

FUNDING INFORMATION

11 What type of income do

you have?

Salary / Wages from a job income

Disability Support Pension A mobility Allowance

Centrelink payment (not DSP) Compensation

None Other

12 Can you describe your funding and where your

community supports come

from?

Accommodation Support Funding Intensive Family Support Funding

Post School Options/ Alternatives to

Employment Funding

13 Do you know what model or program is your funds

managed?

Shared Management

Shared Management with Coordination Provider Management

14 How do you manage your money?

None, someone makes all money decisions for me

A small amount of spending money is

given to me periodically Most of my money, but someone does

help me make major decisions I make all my own money decisions (or

if in a partnership a shared decision with a partner)

COGNITIVE

15 Do you need any help with making decisions for things

to do?

I have help with all my decisions from day to day and major items (family/

advocate) I don’t participate in any part of making

decisions on a day to day basis; most of it is worked out for me

I have help with all major decisions

only, able to make choices with day to day tasks family/ advocate/)

I share the my decision making with a

partner/advocate

No problems at all I make all my decisions alone.


ACCOMODATION SETUP

16 Who do you live with?

Alone My Family

Friends / Partners Accommodation Support worker

A Foster Family

A Host Family Other;

17 If you don’t live with your family how do you contact

them?

GENERAL ACTIVITIES

18 In a typical week how

many days do you get out of your house and go

somewhere?

Number of Days

19 Can you enter and exit your home without

assistance from someone?

Yes No

20 How do you get around your home and

community?

Walking unaided independently Wheelchair/ mobility aid independently

Wheelchair / mobility aid with physical assistance

Walking / aid with supervision Dependent on carer to mobilise

21 How many hours per week

do you spend doing recreational activities?

Don’t not include time spend watching TV or listening to the radio

22 How many hours per week do you spend doing some

form of work (paid or voluntary), training or

study?

Type Hours

23 How many people

(friends/family) did you phone or email in the last

month?

None

1-2 3-5

6 or more

24 How many places

(business/ organisation) did you contact via phone

or email in the last month?

None

1-2 3-5

6 or more

SPECIFIC AT TASKS COMPUTER & INTERNET ACCESS ID Question Selection Comments

25 Do you have access to a computer & internet?

I am still using the computer Question 27

I never used the computer Question 42

I no longer use the computer Question 26

Type internet access

26 Why did you stop using the computer?

My condition changed I have switched to a different set

up I no longer use any computer

My computer is broken / not

usable Other

27 Whose idea was is to

try using a computer and the internet?

28 How did you ask or trial this type of

equipment?

29 How was this equipment funded?

30 How often do you use

the computer?

Daily

A couple times a week Once a week

A couple times a month Rarely

31 Can you physically

access the equipment?

I can never access the equipment

I almost always have difficulty I sometimes have difficulty

I almost never have difficulty

I can always access the equipment

32 Do all your support

team (carers/ family) know how to use and

set up this piece of

equipment?

Yes

No

How Many?

33 Do you need someone

to physically set up and

turn on the computer?

Yes

No

34 What kind of

assistance is required

to support the use ONCE the computer is

on?

MAXIMUM ASSISTANCE/

DEPENDANT

PHYSICAL ASSITANCE ONLY MODERATE SUPERVISION/

ASSITANCE MINIMAL SUPERVISION/

ASSITANCE INDEPENDENT

35 What is your Assistive Technology set up to

access this?

Hardware Software

36 Who requested the

assessment for this equipment?

37 If your computer is not working, can you

access and alternative options?

What? How?


38 How important do you feel the computer &

internet is to your life? (select number)

Not Important Extremely important

1 2 3 4

5

39 How satisfied would you rate with your

current computer set up?

Not Satisfied Extremely Satisfied

1 2 3 4

5

40 How much difficulty did you experience

adjusting to using the computer ?

Extreme Difficulty No difficulty at all

1 2 3 4

5

41 Why do you use the

computer?

(More than one option can be selected)

Social Networking

Shopping

Banking Education

reading Video/ Music

General Surfing

Document management Work

Other

42 Would you like to use a

computer?

Yes

No

43 What would you like to use the computer for?

(More than one option can be selected)

Social Networking Shopping

Banking

Education reading

Video/ Music General Surfing

Document management Work

Other

PIADS FORM

COMPLETED

NON APPLICABLE

TELECOMMUNICATIONS ID Question Selection Comments

44 Do you use a

telephone?

I am still using the telephone Question 46

I never used the telephone Question 46

I no longer use the telephone that was provided Question 45

What? (landline /TTY /

Mobile)

45 Why do you no longer use a telephone

provided?

My condition changed I’ve switched set ups

I no longer use any form of

telecommunications My access is to difficult

Other

46 How do you let

someone know you want to use the phone?

47 What kind of mobile

phone access to you have ?

48 What would you use

the phone for if you could access it with

minimal assistance?

49 Who funds this

equipment?

50 What is your set up for the phone?

51 Can you physically

access the telephone at home?

I can’t access the equipment

I almost always have difficulty I sometimes have difficulty

I almost never have difficulty

I can always access the equipment

52 If you have access or

irregular set up does everyone at home know

how it works?

Yes

No

53 Can you answer the phone yourself?

Yes No

How?

54 What kind of assistance

do you need once the phone has been

answered or dialled?

MAXIMUM ASSISTANCE/ DEPENDANT

PHYSICAL ASSISTANCE ONLY MODERATE SUPERVISION/ ASSITANCE

MINIMAL SUPERVISION/ ASSITANCE INDEPENDENT

55 Who requested having

a specialised phone at home for you to use?

56

Are there any problems

you find using the phone set up?

57 What do you do if your equipment isn’t working

properly?


58 How important do you feel the telephone is to

your life?

(select number)


1 2 3 4 5

59 How satisfied would

you rate with your

current telephone set up?

(select number)

Not Satisfied Extremely

Satisfied

1 2 3 4 5

60 How much difficulty did

you experience

adjusting to using the telephone ?

(select number)


1 2 3 4 5

PIADS FORM COMPLETED NON APPLICABLE

AUGMENTATIVE & ALTERNATIVE COMMUNICATION DEVICE (AAC) ID Question Selection Comments

61 How do people understand what

you are trying to

say?

62 Do you use an Augmentative &

Alternative

Communication Device / System?

Yes Complete PIADS

Background FORM

No Question 74

63 Have you used any communication

aids in the past?

Yes Complete PIADS

background FORM

No

COMPLETE PIADS BACKGROUND FROM

64 Do you think you

would benefit from

having some sort of communication

system?

Yes

No Question 74

What for?

65 Do you have a

speech

pathologist? When did you last see

them & Why?

Yes

Not recently

Never

When?

What for?

66 Who suggested

you consider trying one?

67 How often do you

use this?

68 Does everyone in

your support team

know how to use the device?

Yes

No

69 Do you need someone to

physically set up &

turn on the device?

Yes No

70 What kind of

assistance is

required to support the use once the

AAC device is up and running?

MAXIMUM ASSISTANCE/

DEPENDANT

PHYSICAL ASSISTANCE ONLY

MODERATE SUPERVISION/

ASSITANCE MINIMAL SUPERVISION/

ASSITANCE

INDEPENDENT

71 If the AAC is

broken what do you use to

communicate with?

72 What & Where do you use your

communication system?

73 Is this device

linked in with an ECU or other

system?

Yes

No

What

74 Would you like to

try some form of AAC or

communication system to support

your

understanding?

75 What would you

like to use the AAC

system for?

PIADS & Background

FORM

COMPLETED NOT APPLICABLE

ENVIRONMENTAL CONTROL UNITS (ECU) ID Question Selection Comment

76 How you able to activate your TV/ DVD etc?

77 How do you open your

door at home?

78 How do you adjust your ac

or heaters?

79 How do you turn on/ off lights?

80 How do you call someone

when you are in trouble?

81 Are you using any type of

Environmental Control

System?

Yes Complete PIADS Background FORM

No Question 88

What

82 Have you used any types of ECU in the past?

Yes Complete PIADS Background FORM

No Question 88

What

COMPLETE PIADS BACKGROUND FORM

83 Do your support team (carers/ family) know how

to use and set up this piece of equipment?

Yes No

Some

84 If you use some form of ECU who suggested you

look at alternative access?

85 Who assessed you for this

equipment?

86 Who funded this equipment

87 What kind of assistance is

required to support the use once the controls are up

and running?

MAXIMUM ASSISTANCE/ DEPENDANT

PHYSICAL ASSISTANCE ONLY MODERATE SUPERVISION/ ASSITANCE

MINIMAL SUPERVISION/ ASSITANCE INDEPENDENT

Describe

88 Do you have another form of activating your

equipment if the ECU is not work?

Yes No

89 Would you like to use ECU at home?

Yes No

What for?

PIADS +

Background FORM

COMPLETED

NOT APPLICABLE

NIGHT TIME POSITIONING EQUIPMENT ID Question Selection Comments

90 Do you use any form of night-time positioning

equipment?

Yes No

What?

91 Have you used any in the past?

Yes No

What?

92 What is your set up at

night going to bed?

What were the outcomes?

93 What do you see as the

benefit of having some bed positioning equipment?

94 Who requested the

assessment for this

equipment?

95 Who funded the

equipment?

96 Does your support team

know how to use the

equipment?

Yes

No

Some

97 Do you have another form

of positioning in bed if yourself in bed if the

system is broken?

Yes

No

98 How important do you feel the positioning equipment

is to your life?

(select number)


1 2 3 4 5

99 How satisfied would you

rate with your current set up?

(select number)

Not Satisfied Extremely

Satisfied

1 2 3 4 5

100 How much difficulty did you experience adjusting to

using the equipment?

(select number)


1 2 3 4 5

PIADS COMPLETED

NOT APPLICABLE

GLOSSARY OF TERMS & DEFINITIONS

DSC – Disability Services Commission PIADS – Psychosocial Impact of Assistive Devices Scale AT- Assistive Technology ECU – Environmental Control Unit AAC – Augmentative & Alternative Communication SHARED MANAGEMENT involves people with disability and/or their families managing and co-ordinating their own services, but having an approved organisation such as an organisation administer the funds SHARED MANAGEMENT WITH CO-ORDINATION involves people with disability and/or their families employing their own support people (as in Shared Management above), but having the organisation administer the funds and co-ordinate all aspects of the service PROVIDER MANAGEMENT involves having organisation administer the funding on behalf of the person with disability, co-ordinate their services and employ their carers. MAXIMUM ASSISTANCE / DEPENDENCE -Someone else is always with me and has to complete control over the use of the equipment. PHYSICAL ASSITANCE ONLY - Someone else is there and I direct them towards what I want them to do MODERATE SUPERVISION/ ASSITANCE -Someone else is always with me to observe and assist me MINIMAL SUPERVISION/ ASSITANCE - Someone else is always around, but they only check on me now and then INDEPENDENT -I am left alone without anyone checking on me ABS Classification self care, mobility and communication are defined as core activities. The ABS defines levels of core activity restriction as follows: MILD — where a person has no difficulty with self care, mobility or communication, but uses aids or equipment; MODERATE — where a person does not need assistance, but has difficulty with self care, mobility or communication; SEVERE — where a person sometimes needs assistance with self care, mobility or communication; and PROFOUND — where a person is unable to perform self care, mobility and/or communication tasks, or always needs assistance.

Evana

Typewritten Text

Evana

Typewritten Text

52

Glossary of PIADS Items Ability to Adapt to the Activities of Daily Living (item 25) Ability to cope with change; ability to make

basic tasks more manageable

Ability to Participate (item 23) Ability to join in activities with other people

Ability to take advantage of opportunities (item 26) Ability to act quickly and confidently when there is

a chance to improve something in your life

Adequacy (item 4) Capable of handling life situations, and handling little crises

Capability (item 16) Feeling more capable; able to cope

Competence (item 1) Ability to do well the important things you need to do in life

Confusion (item 5) Unable to think clearly, act decisively

Eagerness to Try New Things (item 24) Feeling adventuresome and open to new experiences

Efficiency (item 6) Effective management of day to day tasks

Embarrassment (item 21) Feeling awkward or ashamed

Expertise (item 13) Knowledge in a particular area or occupation

Frustration (item 10) Being upset about lack of progress in achieving your desires; feeling disappointed

Happiness (item 2) Gladness, pleasure; satisfaction with life

Independence (item 3) Not dependent on, or not always needing help from, someone or something

Performance (item 18) Able to demonstrate your skills

Productivity (item 8) Able to get more things done in a day

Quality of Life (item 17) How good your life is

Security (item 9) Feeling safe rather than feeling vulnerable or insecure

Self-Confidence (item 12) Self-reliance; trust in yourself and your abilities

Self-Esteem (item 7) How you feel about yourself, and like yourself as a person

Sense of Control (item 20) Sense of being able to do what you want in your environment

Sense of Power (item 19) Sense of inner strength; feeling that you have significant influence over your

life

Skillfulness (item 14) Able to show your expertise; perform tasks well

Usefulness (item 11) Helpful to yourself and others; can get things done

Well-being (item 15) Feeling well; optimistic about your life and future

Willingness to Take Chances (item 22) Willing to take some risks; willing to take on new challenges

PIADS Background Form – E.C.U. s #____

P. Gryfe & J. Jutai, 1999 - Version 5 PLEASE TURN OVER

Client Name: ID# Today's Date: (m/d/y) 1. � I am still using the device. � I never used the device. � I no longer use the device that was prescribed for me because: (mark all that apply)

Date you stopped using the device (m/d/y) a) � My condition has changed. d) � My ECU is broken & not usable. b) � I have switched E.C.U.’s. e) � Other (specify): c) � I no longer use any E.C.U.

2. When did you obtain your present E.C.U. device(s)? Month _____ Day _____ Year _____ 3. What kind of E.C.U.(s) do you currently have? (mark all that apply) a) � Scanner to operate: TV, VCR, CD h) � Air Conditioner / heater

b) � Bed Controller i) � Radio c) � Scanning Telephone j) � Cell Phone d) � Door Operators k) � Water Dispenser

e) � Window blinds l) � Specialized Computer Controls

f) � Satellite Dish m) � Other (specify): g) � Lights

4. How do you access your E.C.U.? (mark all that apply) a) With hand(s) � right � left h) � Sip and Puff b) With your foot/feet � right � left i) � Mouth Stick c) Joystick control � right � left j) � Tongue Switch d) � Modified Joystick (e.g. U-stick, T-Stick) k) � Tiller bar e) � Midline Controller (Custom Mount) l) � Voice Recognition Control f) � RIM Controller (Head Joystick) m) � Other (specify): g) � Peach-tree 5. Has there been any change in the amount of time that you use your device since getting it? (mark one)

I use it: a) � as much as I always have. b) � more c) � less d) � other : 6. Why do you use your device? (mark all that apply) a) � It's the only way I can operate things independently. d) � So that I can manage my environment. b) � So that I feel less anxious. e) � Other (please specify): c) � So that I feel less self-conscious. In the next 3 questions please circle a number between 1 and 5. 7. How important do you feel the device is to your life?

Not Important 1 2 3 4 5 Extremely Important 8. How would you rate your satisfaction with your present device?

Not Satisfied 1 2 3 4 5 Extremely Satisfied 9. How much difficulty did you experience adjusting to your present device?

Extreme Difficulty 1 2 3 4 5 No Difficulty At All

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PIADS Background Form – VOCA s #____

P. Gryfe & J. Jutai, 1999 - Version 5 PLEASE TURN OVER

Client Name: ID# Today's Date: (m/d/y) 1. � I am still using the device � I never used the device. � I no longer use the device that was prescribed for me because: (mark all that apply)

Date you stopped using the device (m/d/y) a) � My condition has changed. d) � My VOCA is broken & not usable. b) � I've switched devices. e) � Other (specify): c) � I no longer use any kind of communication device.

2. When did you obtain your present communication device(s)? Month _____ Day _____ Year _____ 3. What kind of communication device(s) do you currently have? (mark all that apply) a) � Standard Lightwriter g) � Delta Talker b) � Lightwriter with scanner h) � Liberator c) � Message Mate i) � Dynavox d) � Franklin j) � Portable Laptop with Voice Output e) � Walker Talker k) � Other (specify): f) � The Link 4. How do you access your present communication device(s)? (mark all that apply) a) � Direct Selection with two hands (touch-typing) l) � Single switch Scanning b) � Direct Selection with one hand (hunt and peck) m)� Trackball with hand c) � Using your left foot n) � Trackball with foot d) � Using your right foot o) � Headmouse e) � Touch Screen (one-hand) p) � Myoswitch f) � Touch Screen (two hands) q) � Cyberlink g) � Joystick (left) r) � Eye-blink switch h) � Joystick (right) s) � VisionKey i) � Morse Code (one switch) t) � Sip and Puff j) � Morse Code (two switches) u) � Tongue Switch k) � Mouth Stick v) � Other (specify): 5. Has there been any change in the amount of time that you use your device since getting it? (mark one) I use it: a) � as much as I always have. b) � more c) � less d) � other : 6. Why do you use your device? (mark all reasons that apply) a) � It’s the only way I can speak to someone. d) � So that I feel less self-conscious. b) � So people can better understand my speaking. e) � So people feel more comfortable with me. c) � So that I feel less anxious when I speak. f) � Other (please specify): In the next 3 questions please circle a number between 1 and 5. 7. How important do you feel the device is to your life?

Not Important 1 2 3 4 5 Extremely Important

8. How would you rate your satisfaction with your present device? Not Satisfied 1 2 3 4 5 Extremely Satisfied

9. How much difficulty did you experience adjusting to your present device?

Extreme Difficulty 1 2 3 4 5 No Difficulty At All

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APPENDIX 7 : Recruitment and Consent form Dear The access and use of high end Assistive Technology for adults living in a variety of accommodation settings with in WA. My name is Evana Jacobson and I am writing to you on behalf of Independent Living Centre. I am conducting a project that aims to collect data in relation to the use of a specific range of high end assistive technology by adults living in a variety of accommodation support settings. This data will be used to develop and increase the knowledge base of current practice, gaps and future demand from an adult consumer perspective for assistive technology. This project has been funded by the Disability Services Commission. I would like to invite you to take part in the project. This is because the organization working with you has been selected as one of the accommodation settings we have approached to participate in the review. What does participation in the project involve? Your involvement in the project will involve answering a questionnaire (60 mins) that relates to your access and use of a specific group of Assistive Technologies. The interviews will take place at your home starting in October 2010 until December 2010. The data collection will also include some basic information about your environment and supports. The questionnaire can be completed in a single session or over a couple of meetings. The interviews will be recorded and reviewed by myself then the data will be deleted from the recorded device. The results of the information and report will be provided to DSC, you are welcome to request a copy of the final report. Consent to participate Your involvement in the project is entirely voluntary. You have the right to withdraw at any stage without it affecting your rights or responsibilities. When you have signed the consent forms I will assume that you have agreed to participate and allow me to use your data in this project. Confidentiality Information that identifies anyone will be removed from the data collected. The data is then stored securely in a locked cabinet at the ILC (Nedlands), and can only be accessed by the project coordinator. Any recorded material will be deleted from the recorded device once the information has been reviewed by the interviewer. If you wish to participate in the project please contact me by November 2010 to arrange a time to book your interview. Thank you very much for you involvement in this research Evana Jacobson Occupational Therapist & ILC Project Coordinator – AT in Accommodation project Independent Living Centre of WA Email : [email protected] Phone: 9381 0600

mailto:[email protected]

APPENDIX 7 : Recruitment and Consent form

CONSENT FORM

I know I have a choice whether or not I want to do this project

I know I can stop whenever I want.

I know that I will be answering a questionnaire as part of the project

I know I need to demonstrate on this page that I can help with the project.

I understand the information about me will be securely stored for the period of the project and then destroyed.

I know that no personal identifying information about me will be used in the write up of the project.

I have been offered the chance to ask questions about the project.

YES NO I would like to help with project I don’t want to help with the project

Name (participant):

Signature

Date

Name (proxy/advocate):

Signature

Date:

Address

Telephone Contact

Email Contact

APPENDIX 8: Simplfied Recruitment & Consent Form. Hello

My name is Evana Jacobson. I have a project you may like to help me with. The project is about getting to know what equipment you have in your home and how it helps you participate in a range of activities. I am looking at a few areas such as telephones, computers, internet, how you communicate, your bed and being able to use a remote control for your TV or stereo. If you would like to help me out by answering a series of questions, it will take up to an hour, but we can do this over several sessions if you prefer. If you want to stop at anytime, that’s ok you can just let me or someone you trust that you wish to stop being part of my project. I won’t be telling anyone what you have been saying and all your information will be stored in a locked draw at my work. I will be the only person who can access this information. If you would like to help with the project please contact me or let the person who gave you this letter know. I am happy to answer any questions about this project if you, a friend or family member want to talk about this. I can be contacted on 9381 0600 or sent an email [email protected] . Kind Regards, Evana Jacobson Occupational Therapist Independent Living Centre of WA The Niche, Suite A 11 Aberdare Road Nedlands WA 6009 Reception: 08 9381 0600 Facsimile: 08 9381 0611 E-mail: [email protected] Website: http://www.ilc.com.au



http://www.ilc.com.au/

APPENDIX 8: Simplfied Recruitment & Consent Form.

CONSENT FORM

I know I have a choice whether or not I want to do this project

I know I can stop whenever I want.

I know that I will be answering a questionnaire as part of the project

I know I need to demonstrate on this page that I can help with the project.

I understand the information about me will be securely stored for the period of the project and then destroyed.

I know that no personal identifying information about me will be used in the write up of the project.

I have been offered the chance to ask questions about the project.

YES NO I would like to help with project I don’t want to help with the project

Name (participant):

Signature

Date

Name (proxy/advocate):

Signature

Date:

Address

Telephone Contact

Email Contact

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