the mission of tnt is threefold:
DESCRIPTION
Mission. The mission of TnT is threefold: (1) to study prevalence, policy and resources, individualized decision making, training and support and other factors related to use of assistive technology (AT) devices and services in early intervention. - PowerPoint PPT PresentationTRANSCRIPT
The mission of TnT is threefold:
(1) to study prevalence, policy and resources, individualized decision making, training and support and other factors related to use of assistive technology (AT) devices and services in early intervention.
(2) to disseminate current knowledge and research findings in timely ways to families, multidiscipline EI providers, administrators, educators ad policymakers using a variety of methods and approaches.
(3) to partner with parents of children with disabilities, with individuals with disabilities, in the design and implementation of the national research program.
Mission
Child & Family Outcomes
•Families are able to support their children’s development in natural contexts
•Children are able to participate in activities that promote growth and learning in natural contexts
•Children’s growth and learning opportunities are maximized
AT Use & Practices
Federal & State Policy
Community & Financial Resources
Early Intervention Service Providers
Conceptual Model for Understanding AT Use, Practices, and Early Intervention Outcomes
Families & Children
• Understanding AT use & prevalence• Policy and resources for AT in EI• Understanding & improving decision making,
assessment, & typical practices• Identifying & implementing effective training &
resources for system change• Identifying & understanding funding resources
Institute Research Questions
Studies
A total of XX studies have been conducted to date
Studies 1. Policy Studies
• Part C Survey (n = 42 Part C Coordinators)• Tech Act Directors Interview (n = 46 State Tech Act Directors)• State Document Analysis (n= 28 states)• Profile of State Characteristics & Training Summary (n = 51)• Lending Library Survey (n = 39)• Indicator Instrument (in process)
2. Parents• National Parent Phone Survey (n = 924 parents of children
under 3 years of age; 845 whose children had used AT)***• National Parent Web-Based Survey (n = 705)
3. Practitioners:• National EI Practitioner Phone Survey (n = 967)***• National Follow-Up Survey (n = 450 who participated in the
initial study***• National EI Practitioner Web-Based Survey (n = 616)
Studies 4. Evidence-Based Practices review (115
articles from 1980-2003; 38 contained empirical evidence about practices)***
5. Providers self efficacy about AT for infants and toddlers (n=86)***
6. State Implementation Study1. N= XX states (XX teams)2. N= XX interdisciplinary service providers3. N= XX parents4. N= XXX infants and toddlers
Understanding AT Use & Prevalence
• 4% of infants/toddlers nationally have AT listed on their IFSP’s (DOE Report to Congress, 2004) & this number shown little change over the years.
• Approximately 4% of infants & toddlers in the NEILS sample were reported to be receiving AT services
• 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 AT were receiving it.
Infants & Toddlers with AT on Their IFSP
7481 7413
89018213
01000
2000
3000
40005000
6000
7000
8000
900010000
2000 2001 2002 2004
How AT services for infants and toddlers are recorded
On the IFSP
Few AT services are
Some AT services are
Most AT services are
All AT services are
Pe
rce
nt
100
90
80
70
60
50
40
30
20
10
0
(Part C Coordinators)
How AT device is recorded on the IFSP
Not listed
hi-tech/DME only
Part C fund only
All listed/any funds
Pe
rce
nt
100
90
80
70
60
50
40
30
20
10
0
(Part C Coordinators)
What Do These National Data Tell Us?
• AT is not likely to be listed as a service or device on the IFSP’s of infants and toddlers.
• Use, as recorded on the IFSP under the AT category has remained stable. However, this still doesn’t provide us with information about the extent of underutilization.
• There is wide variability in definitions of AT devices across the states
Understanding AT Policy & Resources
0
20
40
60
80
100
State Statute StateRegulations
State Policy StateGuidelines
Local Policy LocalGuidelines
57.5%10%5%25%Requirements for transition to preschool
47.9%13.2%7.9%18.4%Recycling
48.7%10.3%7.7%30.8%Maintenance and repair
10.3%15.4%5.1%66.7%Documentation requirements
36.8%10.5%5.3%44.7%Relationship of AT devices to AT services
14.3%9.5%2.4%73.8%Eligibility for and access to AT services
33.3%12.8%2.4%43.6%Ownership
11.9%16.7%2.4%66.7%Payment for AT devices and services
Not CoveredState and LocalLocalStatePolicy regarding…
Availability of AT ResourcesPart C Coordinators
0102030405060708090
100
EquipmentLoan
LendingLibraries
Information Assessment Cash Grants
Available Not Available Don't Know
Percent States Reporting Availability/Use ofResources
(Part C Coordinators)
20.528.2Purchase devices for ch ild use at home, child care and other settings
12.843.6Provider owned devices loaned to families
7.753.8Purchase devices for use as long as child is receiving Part C services
28.230.8Borrow devices by mail from a library
Not Likely At AllVery LikelyProviders
52.615.8Request loan without a separate assessment or provider approval
33.320.5Borrow devices by mail from a library
Not Likely At AllVery LikelyFamilies
15.834.2Visit an AT lending library and borrow devices
2.666.7Ask for AT assessment
Not Likely At AllVery LikelyProviders or Families
Availability of AT Resources
• Providers -- – 23.6% reported a lot of AT resources in their
communities; 27.6% reported only a few or no resources– 49.6% reported access to loan library
• Parents --– 34.1% reported access to loan library (23.8% did not
know if library existed)• Tech Act Directors --
– 60.7% reported either state-wide or regional lending libraries available for infants & toddlers
• Lending Library Directors --– 28 (72%) report making < 25% of all loans to infants and
toddlers
Identifying & implementing effective training & resources for system
change
0
25
50
75
100
Formal Statewide orRegional Training
Statewide ResourceCenter
Regional ResourceCenter
Technology ResourceFairs
Providers Parents
Type of Training Program/ Intended Audience Reported by Tech Act
Directors
0
5
10
15
20
25
30
35
40
45Num
ber of Training P
rograms (n=
48)
In- service
Pre-service
EI P
roviders E
Is/ F
amilies
Fam
ilies
Service
Provid
ers
EI R
elated
Service
Provid
ers
Sponsors of the Training Programs
0
5
10
15
20
25
30
35Nu
mb
er of Train
ing P
rograms
(n=
47)
Tech Act Part C Tech Act/ Part C University/ Tech Act Other State Agencies Others (Parent org, Prof org, nonprofits)
0
25
50
75
100
619 SICC Health Tech Act Private LendingLibraries
Public LendingLibraries
State Level Collaboration
How well does your state AT project work with the state’s Part
C system?
0
10
20
Num
ber of States
Excellent Adaquate Minimal No Collaboration Not Specified
Identifying & understanding funding resources
Percent of State Funding Sources “Very Frequently”Used to Pay for AT Devices
(Part C Coordinators)
0
10
20
30
40
50
60
70
80
90
100
Part C as Payer ofLast Resort
Private Insurance,Medicaid, or
Other 3rd PartyPayer
Family Funds andPersonal
Resources
State CostParticipation
Program
DME/MedicaidTitle XIX
DMEs/MedicaidTitle V
Part C forExpensive
Items/OtherSources forInexpensive
Understanding & improving decision making, assessment, & typical
practices
Overview of Surveys
• Practitioner Questionnaire and Follow-up Practitioner Questionnaire
• State Coordinator and Deaf-Blind Program Coordinators Survey
• 2nd Provider Follow-Up Study
Overview of Surveys and Samples
Practitioner Survey 1• National Sample of 967 multi-discipline
professionals who worked with a minimum of 3 children per week
• 23-item questionnaire conducted through phone interview
• Provider demographic information• Perceptions and definitions of AT• Prevalence and use of AT• Influences on AT decision-making process
Overview of Surveys and Samples
Practitioner Follow-up Survey•A follow-up survey including 424 of the
multi-discipline professionals who participated in 1st survey and agreed to be re-contacted.
•43-item questionnaire conducted through phone interview
•Provider demographic information•Training and education experience in AT•Decision-making: “What would you do?”
Overview of Surveys and Samples
Deaf-Blind Program Coordinator Survey• 36 state directors/coordinators for programs
for children who are deaf-blind– Representing 30 different states + Puerto Rico
• 30-item questionnaire: A combination of practitioner surveys 1 and follow-up
• Demographic information• Perceptions and definitions of AT• Decision-making: “What would you do?”
Overview of Surveys and Samples
State Coordinators• Same survey as the practitioner follow-up
survey• Provider demographic information• Training and education experience in AT• Decision-making: “What would you do?”• 31 providers representing 21 different states• Nearly all female (1 male)• Disciplines: OT, PT, SLP, CDS, Early
childhood education, AT specialist, Special Education, Social work, Education, Service coordinator, Family support studies.
Under What Conditions Are Providers Most Likely to Recommend AT?
Condition/Situation Very Likely Likely TotalThe child or family want to participate in some activity and can't without the assistance offered by a device
82.1% 11.8% 93.9%
The AT will promote family-child-sibling interaction 76.8% 16.6% 93.4%The child's parent request the use of AT 55.3% 23.0% 78.3%The child is having difficulty with something he or she wants to do
43.6% 24.8% 68.4%
There is a change in the child's condition, such as detection of a vision, hearing, or motor problem
51.9% 24.2% 76.1%
There is a change in the parents' expectations for a child 25.1% 23.5% 48.6%
The child meets and developmental milestone and needs AT to proceed
78.7% 15.3% 94.0%
Other IFSP team members suggest AT for the child 64.8% 23.7% 88.5%There is a change in where the child spends time during the day
24.4% 19.3% 43.7%
New AT is available and makes sense for the child 73.7% 17.1% 90.8%Someone on the team finds out new information about AT that may help the child
56.8% 27.1% 83.9%
The IFSP outcomes have not been achieved 25.0% 20.4% 45.4%Consideration of AT is a part of the IFSP process requirements`
58.4% 15.9% 74.3%
Provider Decision-MakingVariable Extremely Important
The availability of AT 53.4%The parent's attitude toward AT 66.5%
Provider knowledge of AT 40.1%
Technical support for using AT 49.6%
Availability of funding 51.2%Opportunity for trial by borrowing 64.3%Cost of the device 28.7%Red tape or excessive requirements associated with using AT
18.4%
Provider's previous experience with a specific device
24.5%
Appropriateness of the device for child 91.5%
Established policies and procedures related to AT
28.6%
Decision-Making
• Providers’ reported decision-making about when to use AT generally reflects current views about best practices for infants and toddlers who may need AT
• Families and providers beliefs about AT are concordant with one exception – prerequisite skills for AT. This likely reflects a gap between parent and provider decision making processes
• Policy and procedures were not a strong factor that providers would consider in their decision making processes
Providers: Decision-making
What would you do?…..– Playing with toys– Dressing– Crawling and Walking– Bathing– Vocalizing– Eating and Drinking
Case Example 1: Child can hold but not manipulate toys
0
10
20
30
40
50
60
70
80
90
Per
cent
age
SkillDevelopment
Low Tech High Tech No Concern
Coordinators: Deaf-Blind (n=36)
0
10
20
30
40
50
60
70
80
90
Per
cen
tag
e
SkillDevelopment
Low Tech High Tech No Concern
National Sample Providers (n=424)
<12mths
12-24mths
>24mths
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (n=31)
Case Example 2: Child is unable to participate in dressing
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
Skill Development Low Tech No Concern
National Sample Providers (N=424)
<12mths
12-24mths
>24mths
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
Skill Development Low Tech No Concern
Deaf-Blind Coordinators (N = 36)
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
Skill Development Low Tech No Concern
State Coordinators (N = 31)
Case Example 3: Child can not get around by crawling or walking
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
SkillDevelopment
Low Tech High Tech No Concern
National Sample Providers (N=424)
<12mths
12-24mths
>24mths
0
10
20
30
40
50
60
70
80
90
Per
cent
age
SkillDevelopment
Low Tech High Tech No Concern
Deaf-Blind Coordinators (N = 36)
0
10
20
30
40
50
60
70
80
90
Per
cent
age
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
Case Example 4: Child unable to sit up for bathing
0
10
20
30
40
50
60
70
80
90
Per
cen
tag
e
SkillDevelopment
Low Tech High Tech No Concern
National Sample Providers (n=424)
<12mths
12-24mths
>24mths
0
10
20
30
40
50
60
70
80
90
Per
cent
age
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
Case Example 5: Child is struggling not talking and struggling to vocalize
0
10
20
30
40
50
60
70
80
90
Per
cen
tag
e
SkillDevelopment
Low Tech High Tech No Concern
National Sample Providers (n=424)
<12mths
12-24mths
>24mths
0
10
20
30
40
50
60
70
80
90
Per
cent
age
SkillDevelopment
Low Tech High Tech No Concern
Deaf-Blind Coordinators (N = 36)
0
10
20
30
40
50
60
70
80
90
Per
cen
tag
e
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
Case Example 6: Child can not eat or drink without assistance
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
SkillDevelopment
Low Tech High Tech No Concern
National Sample Providers (n=424)
<12mths
12-24mths
>24mths
0
10
20
30
40
50
60
70
80
90
Pe
rce
nta
ge
SkillDevelopment
Low Tech High Tech No Concern
Deaf-Blind Coordinators (N = 36)
0
10
20
30
40
50
60
70
80
90
Per
cen
tag
e
SkillDevelopment
Low Tech High Tech No Concern
State Coordinators (N = 31)
Training
0102030405060708090
100
National Sample Providers (N = 424)
Attended
Very Helpful
0102030405060708090
100
State Coordinators (N = 31)
Overview of Surveys and Samples
2nd Provider Follow-Up Study616 providers45 states21 Item web-based surveyDemographicsActivity and Routine Situations
Characteristics EI Provider I (%)
EI Provider II (%)
N=937 N=616
Female 97.8 93.5
Ethnicity
Caucasian 90.5 83.5
Non-Caucasian 9.5 16.5
Community
Urban 13.4 28.3
Suburban 25.6 43.9
Rural 21.4 27.8
Combination 38.5 ------
Education Level
HS/GED 0.3 4.2
AA 2.0 6.7
BA/BS 35.2 35.0
Master’s 60.5 50.7
Doctoral 2.1 3.4
Primary Setting where Services are Provided
0102030405060708090
100
homecommunity center
Daycare
School
Other
