Fear of Abandonment

This is a guest post by Jeff Symons, MSE, ATP, a rehabilitation engineer located in Northern California. Jeff provides AT and ergonomic assessments to individuals and clients of the California Department of Rehabilitation as well as other agencies.

I recently got feedback from a counselor that many of the clients that I assessed had quit using the voice recognition software I recommended. I also had another client send back a device that I had recommended. I took these as signs to wonder about technology abandonment. I did some research and found two articles that discussed this issue. Click here to access the first article and click here to access the second article. Both articles listed several key factors that may be involved in technology abandonment. These factors are:

1. Lack of consideration of user opinion in selection;
2. Easy device procurement;
3. Poor device performance;
4. Change in user needs or priorities;
5. Assistive technology training;
6. Follow up.

I try during the assessment to discuss the advantages and disadvantages of the options and make sure I understand the user’s perspective. At the end of the assessment I hope that the client, counselor and I are on the same page and agree with what I am going to recommend. We may not always agree on the best solution, but I try to document that in the report.

As I look at these recent instances and the factors of technology abandonment, one conclusion I came to is that follow up and training may be an area that I need to focus on more. I assume that things are going OK unless I hear a complaint, but that may not necessarily be true. In the case of voice recognition software, I have seen a number of people who have stated that it did not work well for them. However, after showing them how well it can work once someone is properly trained, they are generally more interested in learning how to use the program.

I would like to know what reasons people have given for not using what was recommended. I use voice recognition for my reports, and also I'm using it to write this newsletter. I use voice recognition not because I have to, but because it is much faster for me than typing. So again, I would be curious about the reasons people quit using what was recommended.

In the case of the client who sent back a device I recommended even though she had tried it during the assessment, it is likely some follow-up training also may have helped. I do not think she knew how to set up the device and, therefore, did not think it was working properly. A phone call may have solved this problem.

My dilemma is that I would like to follow up with clients to see if they have received the equipment recommended and, if so, to learn how is it working. The problem is that sometimes they have not received recommended equipment for various reasons or their case has been closed. If there is an issue, this could create a problem if we have to re-open their case. I would really like some input and advice as to how to solve this dilemma.

What are your thoughts on technology abandonment? Have you abandoned technology that you thought would meet your needs and later learned that it would not? Any tips you would like to share? 

AT is Going Back to School

Shannon Coe, CFILC’s Reuse & Finance Coordinator, interviewed Nellie DeMeerleer, YO! Volunteer

As students are getting ready for the new school year, I wanted to find out what kind of AT youth are using these days in college.  So I decided to interview Nellie, a youth volunteer for the Youth Organizing (YO!) Disabled and Proud Program.  Nellie is 21-years-old and is also a third year student at Sacramento City College (SCC).  Due to her hydrocephalus, she is blind in the left eye and has Petit Mal Seizures. Nevertheless, Nellie is able to succeed in school because of accommodations, including AT, provided for her by the Disability Resource Center (DRC) at SCC.  In my interview with Nellie, this is what I discovered.

1.    When did you start using Assistive Technology (AT) for school?

I started using AT at a very young age.  In school I use large print because it makes reading less difficult.  I also use a magnifier when large print isn’t available. I also wear glasses to help my Nystagmus and farsightedness.   

2.    What are some of the accommodations you request at school?

Some accommodations I like to have are: a note taker, extra time on tests, a recorder to record the lecture, and a desk in the front of the class.

3.    Which AT do you find most useful and why?

I really like using a recorder for lectures because it makes me less worried about getting all of the notes down. Instead I get to relax and listen to the lecture and participate in class discussions.

4.    How can you access AT in your school?

I get the AT I need at the DRC at Sacramento City College. Once I enroll in my classes and figure out which accommodations I need for each class, my teacher fills out a sheet for me to sign, and I give it to the DRC. 

5.     What made you realize that AT is essential at school and work?

I realized that using AT can help me be more successful at school and work, and that using AT is not a hassle or a stigma anymore.  When I was in high school, there was a stigma with using AT.  But as youth are becoming more aware and open to AT, I see more of my peers using AT in school now. 

  

6.    How has AT helped you be more independent at school or work? 

Using AT makes me feel more independent because I don’t need to ask for assistance at school or work to get my assignments completed.  Also, AT has changed a lot in the last few years.  In the past, I carried 14pt. font large print materials to class but now I only need to carry one book because my teachers post electronic documents online.  All I have to do now is change the font size.  AT has helped me a lot so I encourage other students to take advantage of it. 

After my interview with Nellie, I came to realize how much AT has changed and improved in the last decade, especially the perception of AT among youth.  It no longer has the same stigma as in the past. Now youth with disabilities can succeed in their education without the fear of being different.

Now I want to hear from you. How has AT helped you succeed in school?

Will AT Save IHSS?

By Allan Friedman, CFILC's Technologies Manager

California made a BIG bet in March.  We (the disability community, caregivers and the legislature) bet that AT devices for a few at-risk individuals will save the state $140 million dollars in prevented hospitalizations.  And if we’re wrong? A cut to IHSS hours for all.

When SB 72 was signed into law March 24^th, the clock began ticking on an ambitious pilot project to see if California could reduce Medi-Cal hospital costs by ensuring that patients take their proper dosages of medications at the proper times.  More than a dozen states have succeeded in reducing hospitalizations due to medication mismanagement, so hopes are high.

The technology being piloted is called a Medication Dispensing Machine.  Loaded by the Medi-Cal recipient or caregiver with a month’s supply of medications, the machines are programmed to dispense the proper dosages at the proper times.  The user is alerted with both a visual (flashing light or sign) and auditory signal (a recorded voice, bell or other sound).  If the dispensed meds are not taken in a set amount of time, they are withdrawn into the machine and a text or audio message is sent by telephone to caregivers, doctors or other designated receivers. All dosages are recorded and can be monitored remotely.

But will California realize the savings from this use of assistive technology in time to prevent cuts to IHSS hours?  It's doubtful.  The Department of Healthcare Services has only just begun to work out the details of how they will identify those at risk and how they will deliver the service to them. Their most recent progress report (available on the pilot project webpage) shows that implementation will not start for several more months, most likely in 2012. 

Yet the bill calls for reporting to begin in October and that evidence of savings must be reported to the legislature by April 2012 or else the budget committees will begin planning a reduction in authorized hours for IHSS recipients beginning in October of 2012. This budgeting tactic is being called a "trigger."

The Medication Dispensing Machine Pilot Project has a lot of potential to reduce costs and help consumers stay healthy and out of hospitals.  It is likely that, even with delays to its implementation, it will be continued in the next budget cycle.  But it seems clear that the saving from this program probably will not come soon enough to avert cuts to IHSS services.

How to fund the eyeglasses you need

By Jorge Ruiz, Assistive Technology Coordinator at the Central Coast Center for Independent Living in Salinas

As an assistive technology advocate, I often get requests from consumers on a variety of different pieces of equipment and services. Recently many of our consumers have inquired about funding assistance for basic eye glasses. Of course, before acquiring glasses one must first acquire a prescription from an eye doctor in order to have glasses made. This is the first barrier as many of our consumers don’t have vision coverage or don’t have the resources to pay for those services.  Furthermore consumers often believe that Medi-Cal  can pay for those services.  Here is what Medi-Cal’s vision care policy from their website:

As of July 26, 2010 Medi-Cal again started covering an eye exam from an eye doctor for beneficiaries 21 years or older.

What will Medi-Cal now pay for?

Medi-Cal will now pay for these services if you are any age:

·        To see an eye doctor to test your eyes

·        To test for a prescription for eyeglasses

·        To test for a prescription for contact lenses if you have eye diseases

·        To check the health of your eyes

·        To check to see if you have low vision

What vision-related expenses will Medi-Cal NOT pay for?

Medi-Cal will not pay for these if you are 21 years of age or older (except in some cases):

·        New eyeglasses or to fix your glasses

·        Contact lenses

·        Things that will help you see better (like magnifying glasses)

What are the exceptions?

Medi-Cal will pay for eyeglasses, contact lenses or other things to help you see better for only these people:

·        Pregnant women; and only if your doctor says that not having them will be harmful to your baby or pregnancy

·        Children or people less than 21-years-old who have full Medi-Cal

·        People who live in a nursing home

There you have it. Unless you fit in that small population, you won’t be able to get glasses through Medi-Cal.

As an advocate, my next step is to brainstorm solutions that fill this gap when consumers don’t have the proper coverage to acquire glasses. The first places I look are service organizations like the Lions Club, an organization that recycles eyeglasses throughout the world. Our local Lions Club assisted my consumers in acquiring much needed services. But what can we do when there are no Lions Clubs available to help?

Recently I found out about the organization called New Eyes for the Needy that helps with the cost of prescription glasses for low income individuals in the United States. The applicant submits an application along with a copy of a recent prescription for eyeglasses and, if approved, the applicant receives a voucher from the organization for the cost of glasses. The applicant will then have to find a dispenser that will agree to make glasses for the consumer at the rates printed on the voucher. Once the glasses are made, the organization will reimburse the dispensary for the work completed. The hard part of the program is finding a dispensary that takes the voucher, but once you do, the process is much smoother. Furthermore, the organization is partnering with Wal-Mart vision Center and many Walt-Marts have started taking the voucher.

We often have to think outside of the box to find resources that meet our needs or the needs of the people we serve.

Have you found any new funding sources that fill the gaps that insurance coverage doesn't provide? 

Expanding Access to Communications Technology for the Deaf and Hard of Hearing Communities

By Shannon Ramsay, CFILC’s  Information & Assistance Advocate

We increasingly communicate using advanced devices that zip data back and forth between us over the Internet. Since many of these new types of communication technology have not been designed to be accessible for those of us with hearing impairments, it has become necessary to update and expand existing telecommunications laws to address these accessibility barriers. The 21^st Century Communications and Video Accessibility Act (CVAA) was passed to ensure that this next generation of Internet-based and digital communication technologies is accessible to those of us with hearing and speech disabilities. In this article I will review the changes which the CVAA is making to hearing aid compatibility requirements as well as the expansion of the relay service. 

Until now section 255 of the Telecommunications Act of 1996 only required newly manufactured and imported phones using the traditional public switchboard network to be compatible with hearing aids. Section 255 did not make any provisions for manufacturers of new Internet-enabled phone technology to incorporate hearing aid compatibility into their products. Click here to find out more about past hearing aid compatibility requirements under section 255.

In Title I, section 102, the CVAA extends the current regulations for hearing aid compatibility to include all equipment and devices which offer Internet protocol-enabled (IP) communication services. IP-enabled devices, such as Internet phones, tablets, and PDAs, transmit your voice through the Internet using technologies such as Voice over Internet Protocol (VOIP) instead of the traditional switchboard system. Today many people and organizations use Internet phones to communicate more cheaply and easily, but there is no guarantee that you will be able to hear and understand the person calling you using an Internet phone if you wear hearing aids. The CVAA mandates that the manufacturers of new IP-enabled telecommunications devices must incorporate hearing aid compatibility into new products by including things such as acoustic handsets in their designs. Regulations spelling out the requirements for hearing compatibility of IP-enabled telecommunications devices will be issued by the Federal Communications Commission (FCC) in the fourth quarter of this year. I am personally looking forward to a time when I can use an Internet phone and know that I will not experience any interferences with my hearing aids. 

Right now telecommunications relay services (TRS) are only intended to facilitate functionally equivalent communication between people with hearing and speech disabilities and all other people. Section 103 of the CVAA updates the scope of relay services to require equivalent telephone communication functionality between parties regardless of disability and to increase relay service obligations for all VoIP service providers.     

Have you experienced any difficulties using Internet-enabled communications technology as a person with a hearing impairment?