Transcript Effective Rehabilitation Services

EFFECTIVE RT/AT SERVICE DELIVERY
STATE OF PRACTICE, QUALITY INDICATORS AND ROI IN
THE WORKPLACE
Marcia Scherer, Meera Adya, Deepti Samant, Jurgen Babirad, Mary
Killeen, Nell Bailey
RESNA 2011, Toronto
7/18/2015
Burton Blatt Institute at Syracuse University
Outline
2

Overview of CERT

Current state of practice in RT/AT service delivery

Development of a Quality Indicators Framework
for RT/AT Service Delivery

Return on Investment (ROI)/Costs and Benefits of
Workplace Accommodations

Interactive Discussion
3
I. INTRODUCTION TO CERT
NIDRR Grant No. H133A090004
Need for CERT
4



People with diverse disabilities still experience a
critical gap in awareness and acquisition of suitable
technology products
Barriers to the effective use of rehabilitation and
assistive technology (RT/AT) service delivery widely
speculated but not well researched
Lack of scientifically rigorous research on which
specific elements of RT service delivery achieve
improved employment outcomes
NIDRR Grant No. H133A090004
CERT’s Goals and Objectives
5

CERT’s objective is to close this knowledge gap by
identifying quality service delivery policies,
procedures, and practices that result in the
effective delivery of RT to assist individuals with
disabilities to achieve employment.

CERT is a five year project funded by NIDRR
NIDRR Grant No. H133A090004
CERT’s Goals
6

Conduct research to identify, document, and analyze models of
effective rehabilitation technology service delivery to assist
individuals with disabilities achieve employment outcomes

Identify, test, and develop strategies to support the VR
counselor to make informed and effective decisions in concert
with individual with disabilities to select appropriate RT/AT

Translate findings to policy development and practice and
accelerate and support change at individual and systems level
NIDRR Grant No. H133A090004
Project Outputs
7

Major outputs will include:

A quality indicators self-assessment check list for VR and non-VR
managed service delivery programs.

A model policies and procedures template for “effective service
delivery.”

Development of a new RT assessment tool and measures designed to
create a better match between consumers and technology to advance
employment outcomes.

Technical assistance and training opportunities based on research
findings
8
II. Baseline Survey
Identifying the State of Practice
Baseline Survey
9

Purpose of the survey – identify state of practice:
 Establish a baseline of current practice (services,
systems, policies, practices, and outcomes as well as
barriers and facilitators)
 Help identify the important aspects of service delivery
for detailed assessment and analysis, and
 Allow for comparison across states, and
 Inform the development of the quality indicators
framework
Survey creation process
10


Initial drafting by a core survey team with CERT
using the above methods
Rigorous review process with full project team, Blue
Ribbon Advisory Panel, and invited testers



Requested feedback on every question in the survey pool
regarding importance, relevance to different categories of
service providers and suggestions for modifications
Three similar but separate versions created for State
VR agencies, State AT Act Programs, and CILs
~60 items across 14 categories
Data Collection
11

Baseline surveys widely disseminated through
RESNA, CSAVR, NCIL
 Data collection on State AT Act Program version
complete (38/56 = 68% response rate; 56 is universe)
 Surveys for State VR Agencies in progress (37/80 =
46%; 80 is universe)
 Data collection on CIL activities complete (84/200 =
42%, 50 was targeted limit)
12
State VR Agencies
Consumers served & services provided
13

Top three disability groups served: Multiple disabilities,
sensory impairments, Orthopedic impairments

Reasons why individuals go to VR for RT/AT services:
100%
VR Agencies
88.00%
75%
72%
47%
Employment

Education
Transportation Home-based
needs
Community
participation
Top three types of RT/AT services provided:

1. Job/Workplace Accommodations 2. Computer Applications 3.
Technology for visual impairment (includes agencies for individuals
with blindness/low vision)
Personnel
14

Who is involved in providing RT/AT services? (n = 36)



Educational qualifications of RT/AT staff (n = 34)


Bachelors degree (38%), Masters degree (35%), Other (15%)
61% require specific certifications and licensure (n = 36)


ATPs (92%), CRCs (69%), Low vision specialists (69%)
Audiologists (50%), Driver rehab specialists (50%)
ATP certification from RESNA, CRC
81% require/encourage RT/AT personnel to undergo ongoing
training and continuing education (n = 37)
VR agencies - Barriers
15

Top three challenges to appropriate use of RT/AT
specialists within agency:
Time constraints of the RT specialist (41%)
 Time limitations on the RT/AT assessments that can be
provided (31%)
 Lack of RT specialists (31%)


Program perceived gaps in providing RT/AT to a
consumer (n = 39):

Availability for supports, assistance, accommodations and
maintenance for successful use (49%)
VR and Employers
16

91% assist employers in identifying RT/AT needs and
solutions for individuals with disabilities (n = 32)

Types of services provided:
Assessment (100%)
 Device selection (100%)
 Device training (100%)
 Device modifications (89%)
 Maintenance and repair (50%)

RT/AT in vocational evaluations
17

Limited funding is not a challenge to using RT/AT in
vocational evaluations

87% assess the need for RT/AT during vocational
evaluations

RT/AT services considered at which status:
 100% during IPE development (status 10, 12)
 91% while providing services (status 14, 16, 18)
 84% during placement/follow-up (status 20,22)
Matching consumer and RT/AT
18

The following requirements of RT/AT solutions are
matched with consumer resources:
 Most often: Training, Cognitive demands
 Less often: Physical/Sensory demands of the RT/AT
including use and maintenance, Support services and
maintenance, environments
 Least often: Expense, Method of service delivery
Underserved
19





Many respondents noted partnerships with other community
agencies which serve underrepresented populations,
churches, senior centers, village community centers etc.
Partnerships with independent living centers and IL
specialists
Partnerships with Agrability programs , subcontracts to
universities
Conduct outreach and awareness services through health
fairs, county health departments, job fairs, community
events
Designated and dedicated staff for community outreach
activities
20
State AT Act Programs
Consumers served
21

Top three disability groups served: Multiple disabilities,
sensory impairments, Orthopedic impairments

Reasons why individuals go to AT Act programs for RT/AT
services:
State AT Act Programs
86%
86%
81%
76%
52%
Employment
Education
Transportation Home-based
needs
Community
participation
Services provided
22

Top three types of RT/AT services provided:


Programs available:






Alternative and Augmentive Communications, Computer
Applications, Technology for visual impairment
Device loan programs (83%)
Device demonstration programs (67%)
Device exchange programs (58%)
Reuse or refurbish programs (58%)
Used equipment referrals (54%)
67% have alternative financing programs
Personnel
23

Educational qualifications of RT/AT staff (n = 29):
 Bachelors degree, 50%
 Masters degree, 19.2%
 Some college, no degree, 15.4%

59% require specific certifications and licensure (n
= 30)
 ATP certification from RESNA
 ATACP, ATS
Challenges
24

Top three challenges in using RT/AT services (n =
28)
25
15
Access to appropriate
equipment resources
35
25
Never
19
38
38
5
Seldom
Limited staff resources
Occasionally
19
RT/AT specialist not
available
5
38
10
29
Frequently
Almost Always
0
10
20
30
40
50
60
Percent
70
80
90 100
Matching consumer and technology
25

The following requirements of RT/AT solutions are
matched with consumer resources:
 Most often: Physical, sensory, and cognitive
demands for selected RT/AT
 Less often: Expense, support services and
maintenance, training, and environments
 Least often: Method of service delivery
State AT Act Programs - Barriers
26

Top three program perceived gaps in providing
RT/AT services to a consumer:
 Understanding user perspectives on, attitudes about,
and comfort with RT/AT
 Assessing the fit between RT/AT and the environment
in which it will be used
 Availability for supports, assistance, accommodations
and maintenance for successful use
Outreach to underserved groups
27

Top three approaches used:
Remote access AT Loan Programs
 Partnerships with external on-site service providers
 Remote device demonstrations, one on one onsite
assistance


Many respondents noted partnerships with other
community agencies which serve underrepresented
populations, senior centers, village community centers
etc.
28
Centers for Independent Living
Consumers served & services provided
29

Top three disability groups served: Multiple disabilities,
sensory impairments, Orthopedic impairments

Reasons why individuals go to CILs for RT/AT services:
Centers for Independent Living
59%
68%
89%
84%
73%
14%
Employment

Education
Transportation Home-based
needs
Community
participation
Other
Top three RT/AT services provided:

Architectural accessibility (includes home and outside), Computer
Applications, Technology for visual and hearing impairments
Personnel
30

Educational qualifications of RT/AT staff (n = 52):


Bachelors degree, 31%
Other, 29%


Greater weight given to real world and life experiences with
technology and disability
Some college, no degree, 14%

55% had a designated RT/AT expert on staff

Although a majority (53%) do not require specific
certifications and licensure for RT/AT staff, 88%
require/encourage RT/AT personnel to undergo ongoing
training and continuing education
Challenges in providing RT/AT
31

A significant majority of CILs cited budget
constraints as a barrier to the purchase (78%) and
provision (64%) of RT/AT to consumers

53% stated that funding available to RT/AT
specialists for purchase of devices was insufficient,
and 37% noted no such funding was even available
Decision making on RT/AT
32

Top three factors that impacted decision-making
about RT/AT services (n = 37):
 Financial/ funding considerations (81%)
 Consumer goals (78%)
 Consumer functional need (43%), consumer/family
requests (43%)
Outreach to Underserved groups
33

Advertising through newspapers, radio, TV, and
marketing in schools, rehab facilities, public areas
such as laundromats and stores

Participation in events that draw crowds including
fairs (state, health, job), blood drives, DME drives

Hire individuals from rural areas to spread the word
in the community
CILs and Employers
34

75% assist employers in identifying RT/AT needs and
solutions for individuals with disabilities (n = 36)

Services provided:
Assessment (75%)
 Device selection (68%)
 Device training (54%)
 Device modifications (32%)

Innovative programs
35




Across respondent groups, participants highlighted services
available in state as whole
Low or zero interest loan programs
Reuse, recycling, and reutilization programs (offered through
the respondent groups or private resources such as
Craigslist)
Assistance to fill out funding applications


E.g. A State AT Act Program that trains staff on locating public and
private funding, who then help consumers to complete funding
justifications, and submit documents
$500,000 of AT acquired in past 12 months.
Summary
36





A broad snapshot into the current state of practice
VR agencies are the key providers of RT/AT to aid in
employment and workplace accommodations
All three stakeholders show common traits in the highest
disability groups served: Multiple disabilities, sensory
impairments, Orthopedic impairments
TBI, cognitive disabilities, and psychosocial disabilities least
served
Computer applications and technologies for visual
impairments are most common across providers
Summary
37

Funding for RT/AT services varies with mission and mandate

CILs experience demand but lack adequate funding to meet demands

All groups partner with other stakeholders to provide RT/AT
services including CRPs, university based programs, private
consultants and other government agencies

Providers use multiple marketing strategies, remote assistance
units, and partnerships with appropriate consumer groups to
reach out to underserved groups
Programs based on innovation and creativity in how AT is
funded and accessed are highlighted: low interest loans,
recycling, and assistance in identifying funding sources

38
III. Quality Indicators
NIDRR Grant No. H133A090004
Developing Quality Indicators
39

Phase I:
1.
Review literature to identify core categories of quality in RT/AT service
delivery programs
2.
Refine set of QI categories in collaboration with all project staff and Blue
Ribbon Advisory Panel
3.
Collect baseline data in identified QI categories from 3 key constituencies
delivering AT/RT (AT Act programs, VR agencies, IL agencies)
4.
Form working group from Blue Ribbon Advisory Panel to create indicators
in each category using expert input (Delphi method)

1.
Phase II:
Test, modify and validate framework through in-depth program case
studies of model programs (VR, Employer, and Alternative models)
NIDRR Grant No. H133A090004
Developing Quality Indicators
40

Phase I:
Review literature to identify core categories of quality in RT/AT service
delivery programs
1.
a.
CERT Staff created a working draft for discussion and refinement with Blue
Ribbon Panel.
NIDRR Grant No. H133A090004
Developing Quality Indicators
41

Phase I:
1.
Review literature to identify core categories of quality in RT/AT service
delivery programs.
2.
Refine set of QI categories in collaboration with all project staff and
Blue Ribbon Advisory Panel
a.
Whole project staff and Blue Ribbon Advisory Panel met in December 2010 to
identify 14 categories or domains of interest.
b.
Working draft refined and transferred to Work group.
c.
Over 100 concerns with varying levels of potential measurement identified.
NIDRR Grant No. H133A090004
QI Core Categories (Domains)
42
1.
Organizational Governing
Structure
8.
Funding for AT/RT services
9.
Pre-Service and Continuing
Education
2.
Personnel
3.
Consumers
10.
Marketing of Services
4.
Policies and Procedures
11.
Quality controls
5.
Role and degree of stakeholder
involvement
12.
Data management systems
13.
Evaluation of processes and
outcomes
14.
Innovations
6.
Service Delivery Models
7.
Individualized Matching of
Person and Technology
NIDRR Grant No. H133A090004
Developing Quality Indicators
43

Phase I:
1.
Review literature
2.
Refine set of QI categories
3.
Collect baseline data in identified QI categories from 3 key constituencies
delivering AT/RT (AT Act programs, VR agencies, IL agencies)
a.
Burton Blatt Institute at Syracuse University – Blue Ribbon / Staff Group
b.
Pass it on Center – Georgia: http://www.passitoncenter.org/
c.
Quality Indicators of Assistive Technology Consortium:
http://natri.uky.edu/assoc_projects/qiat/
NIDRR Grant No. H133A090004
Developing Quality Indicators
44

Phase I:
1.
Review literature
2.
Refine set of QI categories
3.
Collect baseline data in identified QI categories
4.
Form working group from Blue Ribbon Advisory Panel to create indicators
in each category using expert input (Delphi method)
a.
Delphi enables participants to examine group responses with each succeeding
round of review and can alter their views or provide a rationale for sustaining a
divergent opinion.
b.
Use of Checkbox Survey Software to fully engage working group via online survey
form. Responses were anonymous.
NIDRR Grant No. H133A090004
Developing Quality Indicators
45

Phase I:
1.
Review literature
2.
Refine set of QI categories
3.
Collect baseline data in identified QI categories
4.
Form working group from Blue Ribbon Advisory Panel to create indicators
in each category using expert input (Delphi method)
a.
Delphi enables participants to examine group responses
b.
Checkbox Survey Software utilized for anonymous input.
c.
Working group consisted of administration from Georgia AT reuse program,
Nebraska Vocational Rehabilitation and Wisconsin IL Center as well as BBI
Researcher and staff.
d.
100+ group of concerns and 14 domains reduced and synthesized using a modified
Delphi Method.
NIDRR Grant No. H133A090004
Developing Quality Indicators
46

Phase I:
1.
Review literature
2.
Refine set of QI categories
3.
Collect baseline data in identified QI categories
4.
Form working group from Blue Ribbon Advisory Panel to create indicators
in each category using expert input (Delphi method)
a.
Delphi enables participants to examine group responses
b.
Checkbox Survey Software utilized for anonymous input.
c.
Working group consisted of administration .
d.
100+ group of concerns and 14 domains reduced.
e.
11 Categories /Domains with 73 Concerns and 21 measurable indicators identified
and ready for Phase II.
NIDRR Grant No. H133A090004
Developing Quality Indicators
47

Phase I:
1.
Review literature
2.
Refine set of QI categories
3.
Collect baseline data in identified QI categories
4.
Form working group to create indicators in each category using expert
input
NIDRR Grant No. H133A090004
11 Quality Domains
48
Organizational Governing
Structures
Personnel
Consumer Outcomes
Policies and Procedures
Stakeholder Collaboration
Service Delivery Models
Individualized Matching of
Person and Technology
Funding
Quality Control and
Evaluation
Marketing
Innovation
NIDRR Grant No. H133A090004
Organizational Governing Structures
49
Concern
Indicator
1a. Budgets developed with members
and management input.
Review of budget flow chart
procedures show input from staff
through administrative levels.
1b. Budgets and funds allocated
appropriately.
3. The governing body includes an expert Review of organizational chart
in assistive technology service delivery
showing AT lines of
who can provide advice to the governing communication
body.
NIDRR Grant No. H133A090004
Personnel
50
Concern
Indicator
6. There are procedures and strategies in Review of new employee training
place for orienting and training new
materials and schedules.
employees (board members, volunteers)
about AT service delivery within the
organization.
9. The organization requires specific
qualifications or competencies for staff
who select AT/RT
Review of job descriptions for all
AT related staff and identify
minimum qualifications.
Proportion of staff with various
professional credentials (OTR/L,
RPT, SLP, ATP, CDRS and others)
NIDRR Grant No. H133A090004
Consumer Outcomes
51
Concern
Indicator
11. There is a demonstrable increase in
employment outcomes/independent
living.
Degree to which people retained
full time employment for one year
after service.
13. Degree to which people are living
where they choose.
The number of positive responses
to a survey question about
consumer living arrangements.
NIDRR Grant No. H133A090004
Policies and Procedures
52
Concern
Indicator
16. The state’s program procurement
policy has a favorable impact on RT/AT
provision.
a. Range of available devices
b. Cost of devices
c. Timing of provision
d. Coordination of device and service
delivery
e. Availability of follow-up
f. Availability of repair and
maintenance
Review network of service provider's
agency engages for AT service.
Review and classify relationship
(contract, fee for service, open
market etc.)
20. RT/AT services are available to support
employment for all consumers regardless
of type or severity of disability
Percent of referrals not admitted or
accepted for service.
Review/classify denial rationale.
NIDRR Grant No. H133A090004
Developing Quality Indicators
53

1.
Phase II:
Test, modify and validate framework through in-depth program case
studies of model programs (VR, Employer, and Alternative models)
NIDRR Grant No. H133A090004
54
Workplace Provision of AT/RT
Quantitative Survey Findings
NIDRR Grant No. H133A090004
Workplace Provision of AT/RT
55

Objectives:
 Understand what technology-based accommodations
are provided in the workplace
 Understand changes experienced over time with
respect to those types of accommodations
 Understand the return-on-investment of those types
of accommodations
NIDRR Grant No. H133A090004
Survey Sample
56

N~ 2, 000


Gender:


49.3% Female 50.7%
Male
Ethnicity:


1, 686 with disabilities
81% White
Education:

40% Bachelor’s Degree
NIDRR Grant No. H133A090004
Accommodations & Disability
57


47% (n=1, 111) use accommodations
Of 863 respondents, only 41% indicated that the
accommodation was for a health condition or
disability
NIDRR Grant No. H133A090004
Technology Accommodations
58

781 respondents indicated that they used “new or
modified equipment/assistive devices”
 45% used computers or other IT
 36% modified their computers or other IT
 33% used other new equipment
 14% modified other equipment
 12% noted “other” types of equipment/AT

~90% of folks who use assistive devices at work,
also use them at home
NIDRR Grant No. H133A090004
Changes Over Time
59

Of 859 respondents, 40% noted their technology
needs as an accommodation changing over time
in their workplace
 50% noted changes in job function or role
 47% noted changes in functional abilities
 48% noted that different technology had become
available

Of 339 respondents, 47% had asked for additional
accommodations because of changing needs
NIDRR Grant No. H133A090004
Employee perceptions of one-time cost of accommodation for the individual who received
accommodations
Employee
One-time cost of
accommodation for the
individual
$0
$1-100
$101-500
$501-1000
$1,001-$5000
More than $5000
Don't Know
Total
60
Count
Does not have
disability
155
Has disability
326
% within pwdisab
69.8%
50.6%
Count
19
74
% within pwdisab
8.6%
11.5%
Count
19
94
% within pwdisab
8.6%
14.6%
Count
10
63
% within pwdisab
4.5%
9.8%
Count
7
43
% within pwdisab
3.2%
6.7%
Count
2
12
% within pwdisab
.9%
1.9%
Count
10
32
% within pwdisab
4.5%
5.0%
Count
222
644
% within pwdisab
100.0%
100.0%
Employee perceptions of one-time cost of accommodation for the company
Employee
One-time cost of
accommodation for the
company
$0
$1-100
$101-500
$501-1000
$1,001-$5000
More than $5000
Don't Know
Total
61
Count
Does not have
disability
Has disability
69
118
% within pwdisab 30.4%
18.5%
Count
94
31
% within pwdisab 13.7%
14.8%
Count
137
42
% within pwdisab 18.5%
21.5%
Count
102
36
% within pwdisab 15.9%
16.0%
Count
82
29
% within pwdisab 12.8%
12.9%
Count
46
4
% within pwdisab 1.8%
7.2%
Count
58
16
% within pwdisab 7.0%
9.1%
Count
637
227
% within pwdisab 100.0%
100.0%
One-time cost of accommodation for the company * Accommodation requested for health or disability purposes
One-time cost of
accommodation for the
company
$0
$1-100
$101-500
$501-1000
$1,001-$5000
More than $5000
Don't Know
62
Total
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
disability purposes
Count
% within Accommodation
requested for health or
Accommodation requested for
health or disability purposes
No
Yes
117
68
23.2%
19.2%
Total
185
21.6%
62
12.3%
63
17.8%
125
14.6%
103
20.4%
76
21.5%
179
20.9%
87
17.3%
50
14.1%
137
16.0%
61
12.1%
49
13.8%
110
12.8%
32
6.3%
18
5.1%
50
5.8%
42
8.3%
30
8.5%
72
8.4%
504
100.0%
354
100.0%
858
100.0%
Perception of benefits
63

Majority estimated significant positive impact on:
 Possibility of working at this company
 Amount of work for colleagues
 Coworkers’ attitude and support
 Level of productivity – quantity of work
 Level of job performance – quality of work
 Level of attendance
 Level of morale or job satisfaction
 Timeliness of projects
 Turnover intention
 Level of self-esteem, communication

Majority estimate total dollar value of these benefits to be at least over
$1000, some ranging to over $10,000
Qualitative Interviews
64

25 employees with disabilities who have requested
accommodations for the workplace

25 supervisors of employees with disabilities who
have requested accommodations in the workplace
NIDRR Grant No. H133A090004
Occupations
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Geologist
Program director
Legislative liaison
Contracting officer
Freelance writer
Ski instructor
Technology consultant
Hotel operator
Computer programmer
Paralegal
Mechanical engineer
Program Manager
Secretary
International marketing consultant
NIDRR Grant No. H133A090004
Types of Disabilities
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Blindness
Hearing impairment
Quadriplegia
Cerebral palsy
Parkinson’s disease
Mobility impairment
Fibromyalgia
Transverse myelitis
NIDRR Grant No. H133A090004
Preliminary Qualitative Findings
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Individuals received funding for their work-related
accommodations through state VR agencies only if they
requested accommodations through VR while they were
looking for a job or if they acquired a disability while on the
job.
Once they were employed or their initial accommodations
were met, they could no longer receive assistance from VR
for any further accommodations needs.
If however, they were to move to another state and begin a
job hunt, they could again receive state VR assistance and
funding in obtaining further needed accommodations,
including new equipment and upgrades.
NIDRR Grant No. H133A090004
Findings continued
68
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The individuals in the sample who received VR funding for
their accommodations did so due to their prior knowledge
of VR practices and policy, not because they sought services
through VR for obtaining a job.
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Office budgetary concerns influenced whether or not some
employees in the sample requested needed
accommodations.
NIDRR Grant No. H133A090004
Findings continued
69
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Some reported that they were not able to work to their
potential without these accommodations. Others purchased
their own assistive technology if they could afford it.
When accommodations requests were denied by their
employers, employees said they became frustrated by how
this affected their productivity. Some worked on strategies
to address the situation; others mentioned the possibility
of quitting their jobs and going on disability.
Those who received appropriate accommodations stated
they felt integrated into the workplace and reported
receiving support for their career development.
NIDRR Grant No. H133A090004
For further Information:
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Please visit our website:
http://bbi.syr.edu/projects/cert/cert.htm
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Please contact:
Deepti Samant
Senior Research Associate
Burton Blatt Institute
[email protected], +1-202-296-5393
NIDRR Grant No. H133A090004