Abstract
Infants and toddlers with disabilities and special health care needs (SHCN) have complex habilitative and health care needs requiring multiple services throughout their lives. Providers of services to children underutilize assistive technology (AT) and AT services. This underutilization has a significant impact on how well and how easily the children are integrated in home, school, and community activities. The literature indicates that AT is appropriate when the device (a) is related to specific and clearly defined goals that are meaningful to the child and family; (b) takes into consideration practical constraints, such as the environment and funding resources; and (c) results in the child achieving desired outcomes. Using an outcome-driven model this article outlines a 10-step framework that can be used by service providers to guide them in determining the fit between the child's needs and AT and/or AT services. Components of the framework and critical information needed for decision-making at each step will be discussed. A family-centered, interdisciplinary team philosophy is promoted.
INFANTS and toddlers with disabilities and special health care needs (SHCN) have complex habilitative and health care needs often requiring a similarly complex array of services throughout their lives. Rehabilitative services and early intervention are increasingly available to children with disabilities and assistive technology (AT) is a critical component of this service array.
In spite of significant advances in AT and AT services, these interventions remain underutilized and poorly integrated into rehabilitation plans for children with special health care needs. The objectives of this article are to first highlight some of the barriers to more effective utilization of AT and then provide a clinical decision-making framework that may help providers incorporate AT and AT services into a system of care for young children with disabilities.
While the number of infants and toddlers using AT has increased by approximately 60% since 1992, this is just a fraction of the number of children receiving early intervention services. Throughout the country only about 7% of the children receiving early intervention services also receive AT or AT services (Technical Assistance Project, 2000). Underutilization can affect the lives of the children, especially with respect to the ease in which they can be integrated into home and community activities. In an effort to increase children's use of AT, the reauthorization of the Individuals with Disabilities Education Act (IDEA) (1997) required Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP) teams to consider each student's need for AT and AT services at the time of plan development.
Assistive technology is any product that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities. Examples include items as simple as a suction cup rattle as well as sophisticated computerized communication devices. Assistive technology services include the services and supports necessary to determine the appropriate technology to meet an individual's needs. Box 1 provides the legal definition of AT and AT services. This definition is used by service providers, policy-makers, and regulatory bodies. The continual advances in technology increase the likelihood that more and more infants and toddlers with disabilities could benefit from assistive devices.
Guidelines for selection of AT have been proposed to promote the appropriate consideration and use of AT. For example, one set of guidelines proposed that AT is deemed appropriate when the device (a) is related to specific and clearly defined goals that are meaningful to the child and family; (b) is compatible with practical constraints, such as funding resources; and (c) results in the child achieving desired outcomes (Judge & Parette, 1998). In order to provide appropriate AT services, providers need the skills and knowledge to address competently
* AT needs and the services to support them,
* Strategies and funding mechanisms to pay for the needed technology and services,
* A strategy for measuring child and family outcomes, and
* Family and contextual factors such as culture, economic status, and geographical location and their impact on both attitudes toward and utilization of AT and AT services.
While requirements for AT and AT services have been legislated and guidelines for implementation have been proposed, there are still significant barriers to full utilization of AT and AT services. Some of these will be discussed below.