using assistive technology with infants and toddlerspdfs/meetings/national2007/1pip...devices. –...

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

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?


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?


• 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



60

70

8090

( )

20

30

40

5060

Perc

enta

ge

0

1020

SkillDevelopment


Case Example 4: Child unable to sit up for p pbathing

National Sample Providers (n=424)90


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


10

SkillDevelopment


Case Example 5: Child is struggling not talking pand struggling to vocalize


60

70

80

90


<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


10

SkillDevelopment



70

8090


20

30

40

5060

Perc

enta

ge

0

1020

SkillDevelopment


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



70

8090

State Coordinators (N 31)

20

30

40

5060

Perc

enta

ge

0

1020

SkillDevelopment


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”?


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


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.


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?


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

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ents

on

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l per

iod

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ding

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rary

av

aila

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rshi

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aint

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men

ts

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ens

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rain

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ovid

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olic

ies

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ools

en Im

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r AT

(IFSP

)

TOTAL SCORE

Geo Lea

%re

por

2002

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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


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


M = 15 c.h. (s.d. 25.8 c.h.)

Video, CD, Manual Self Study


M = 18.9 hours (s.d. 32.4 hrs)

Internet Self‐Study Mentoring (formal)

8 9 ou s (s d 3 s)


M = 24 hours (s.d. 48.9 hrs)


M = 47.5 hours (s.d. 93.4 hrs)

TrainingTraining

90100

National Sample Providers (N = 424)

90100


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

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]