Barriers to the use of assistive technology for children with disabilities

 

JODIE COPLEY Division of Occupational Therapy, University of Queensland, St. Lucia, Australia

JENNY ZIVIANI Division of Occupational Therapy, University of Queensland, St. Lucia, Australia

ABSTRACT: Assistive technology has aided children with multiple disabilities to improve access and participation in their school and home environments. Effective educational outcomes from assistive technology use are dependent upon a coordinated assessment and implementation process. The literature on assistive technology with children was reviewed in order to identify current barriers to its effective integration within schools. These barriers were found to include lack of appropriate staff training and support, negative staff attitudes, inadequate assessment and planning processes, insufficient funding, difficulties procuring and managing equipment, and time constraints. A team model for assistive technology assessment and planning is proposed to optimize the educational goal achievement of children with multiple disabilities. Such a model can help target the allocation of occupational therapy resources in schools to best promote educational and broader functional outcomes from assistive technology use.

Key words: assistive technology, children with multiple disabilities, schoolbased occupational therapy

Children with multiple disabilities often face barriers to accessing and participating in self-care, play, leisure and education (Cavet, 1995). Assistive technology (AT) has been employed as one strategy, particularly in educational settings, to enable these children to participate more fully in various activities (Inge and Shepherd, 1995; Derer et al., 1996; Hutinger et al., 1996; Margolis and Goodman, 1999). Assistive technology includes both low-tech devices (adapted equipment such as spoons with built-up handles) and high-tech devices such as microswitches, electronic communication devices, powered mobility and environmental controls (Parette, 1997). This paper is concerned particularly with high-tech devices.

There is evidence that AT can have significant beneficial effects for children with multiple disabilities (Hutinger et al., 1996; Sullivan and Lewis, 2000). There is also a strong indication, however, that AT is currently implemented within educational environments in a less than optimal manner (Derer et al., 1996; Scott, 1997). The purpose of this paper is to review the literature to identify the potential barriers to AT assessment and implementation for children with multiple disabilities. To this end, ERIC, CINAHL and Medline databases were searched using the keywords of AT, children and multiple disabilities. The results of this search are used to identify existing barriers to the utilization of AT. This is the first step in designing processes that will facilitate positive and sustainable AT outcomes for these children in their educational contexts.

Benefits of assistive technology use

Studies addressing the outcomes of AT use have provided evidence of benefits beyond simply allowing users to perform tasks or functions that they would otherwise be unable to accomplish. Perhaps one of the chief benefits of AT use that is highly relevant for children with multiple disabilities is as a means of enabling mastery or control over their environment, including enhanced exploratory play and independence in activities of daily living (Reed and Kanny, 1993; Hutinger et al., 1996; Cowan and Turner-Smith, 1999; Sullivan and Lewis, 2000). Two comprehensive studies of AT applications in schools (Derer et al., 1996; Hutinger et al., 1996) found that facilitation of independence (including development of autonomy and self-determination) was among the most frequently cited benefits identified by parents and teachers. A commonly reported benefit contributing to self-determination is the ability to make choices and direct one’s own care with the use of augmented or alternative communication (Todis and Walker, 1993; Hutinger et al., 1996). Other outcomes include enhanced social interactions (Mistrett et al., 1994; Derer et al., 1996; Angelo, 2000), and increased motivation and self-esteem (Reed and Kanny, 1993; Swinth and Case-Smith, 1993). A further area that has been demonstrated to improve with the use of AT is skill acquisition and enhancement, such as handwriting, motor skills, reading, visual attention and perception, and maths skills (Reed and Kanny, 1993; Derer et al., 1996; Hutinger et al., 1996). Reported cognitive benefits associated with AT use include understanding of the cause–effect relationship, increased attention span, and problem solving ability (Reed and Kanny, 1993; Todis and Walker, 1993; Hutinger et al., 1996). Teachers have further recounted improvements in general academic behaviour such as work habits and productivity (Derer et al., 1996). Observing the overall benefits associated with the use of AT by children with multiple disabilities, parents and teachers have recognized the capacity of

AT to offer children new opportunities, reveal their potential and provide them with the tools to realize that potential (Derer et al., 1996; Hutinger et al., 1996). Increased awareness of children’s capabilities has, in turn, led to parents and teachers raising their expectations of these children (Anderson, 1995; Hutinger et al., 1996). Yet, despite the potential benefits of AT there are documented shortcomings in its current application with students with multiple disabilities.

Problems in the effective application of assistive technology

Studies of AT utilization have suggested infrequent use of prescribed devices in home, vocational and community settings (Allaire et al., 1991; Derer et al., 1996), poor rates of use by teachers and other professionals who work with children with multiple disabilities (Parker et al., 1990), and concerns regarding the way in which AT programmes are being implemented at school and at home (Hutinger et al., 1994, 1996; Scott, 1997). Reasons given for abandonment of devices have been expressed in broad terms, such as the device being ‘unsuitable’ for the child (Carey and Sale, 1994). Studies that have followed AT usage longitudinally by children with severe and multiple disabilities suggest that it is difficult to identify any one factor that limits effective AT application. Rather, it is likely that problems arise from an interaction of factors associated with the people, services, systems and processes that currently guide AT practice (Todis and Walker, 1993; Carey and Sale, 1994; Hutinger et al., 1994, 1996; Derer et al., 1996; McGregor and Pachuski, 1996). The problematic issues reported in the literature fall into seven broad categories and are discussed below.

Staff training and attitudes

Much of the literature dealing with AT programmes for students with multiple disabilities emphasizes the central role of teachers in the day-to-day implementation of technology plans. Lack of suitable training for school personnel, however, constitutes a major barrier to effective AT implementation (Parker et al., 1990; Hutinger et al., 1994; McGregor and Pachuski, 1996; Parette, 1997). In a survey of 405 teachers, only 19% believed that they had adequate AT training (Derer et al., 1996). Devices were often prescribed and provided without the necessary training and support services being offered (McGregor and Pachuski, 1996; Parette, 1997). Inadequate follow-up support and on-site assistance from consultants and suppliers has also been reported (Parker et al.,1990), leading to a lack of familiarity with the equipment (Carey and Sale, 1994), incomplete awareness of applications that may assist students (Hutinger et al., 1994), and an inability to troubleshoot when the device does not function as expected (Carey and Sale, 1994). Even teachers who have pursued formal training in the area do not believe that this type of training provides them with the skills to use the technology effectively with their students on an ongoing, day-to-day basis (Todis and Walker, 1993; Hutinger et al., 1994). Rather than a single training session (e.g. inservice, workshop) school staff often communicate a preference for on-site, practical support that is available when required (Todis and Walker, 1993; Carey and Sale, 1994;Hutinger et al., 1994).

The training that is available to school personnel has also been criticized for covering the technical aspects of device use but neglecting the purpose and goals of AT programmes (Todis and Walker, 1993; Margolis and Goodman, 1999). The results of a two-year study investigating the implementation of AT with students with multiple disabilities in their school settings support this criticism. Teachers in the study used AT to train isolated academic skills, rather than integrating the technology into daily classroom activity. A further barrier was met when students changed from a more skilled teacher to one with less technology awareness. When this occurred their learning was essentially put ‘on hold’ until the new teacher could gain the necessary skills (Hutinger et al., 1994).

In addition to teachers, occupational therapists have a critical role in the assessment of AT needs and the implementation of device use, particularly in determining ways for the child to interface effectively with the technology (Kanny et al., 1991; Smith, 1992a, 1992b; Reed and Kanny, 1993; Shuster, 1993; Cowan and Turner-Smith, 1999). However, in an examination of occupational therapy training programmes in the early 1990s, minimal course content related to AT was identified, suggesting that occupational therapy graduates may be ill-prepared to fulfil their roles in technology teams (Kanny et al., 1991; Smith, 1992a). Further research by Reed and Kanny (1993) confirmed this assumption, with school-based occupational therapists found to use AT with only a small percentage of their caseload. A principal reason cited for low rates of use was insufficient expertise to allow investigation and application of different devices. While the undergraduate training and continuing education available may have increased since these studies were conducted, so too has the proliferation of AT devices available. It is unlikely that formalized training alone can keep up with the training needs of therapists faced with ever-increasing AT choices.

In addition to issues such as inadequate training, the literature provides examples where student outcomes from AT use are further limited as a consequence of teacher resistance or rejection of AT (Derer et al., 1996). Carey and Sale (1994) suggested that many reasons advanced by teachers for abandonment could have been addressed by staff if they had chosen to do so. For instance, some teachers perceived that students’ use of communication devices interrupted the class and that it was too difficult to manage this behaviour, even though classroom interruptions by verbal students was commonly managed using routine disciplinary measures. The authors proposed that the challenges of AT use created reluctance among staff to commit to AT programmes.

Hutinger et al.’s (1996) two-year study chronicled several situations in which a student’s progress either plateaued or regressed, depending on the teacher’s attitude towards AT. For example, one student could no longer use his communication device after changing classes because the new teacher felt that it would take too much of her time to learn to programme it. Hutinger et al. (1996) suggested that some teachers had no desire to learn to use AT or did not accept that technology could assist their students.

It is possible that staff attitudes are, in part, a response to the systems and processes that are used to introduce the AT to them. In particular, it appears likely that lack of commitment to AT use is compounded when staff members are not integral to the assessment process and involved in decision-making (Todis and Walker, 1993). It could also be that limited administrative support for teacher training allows reluctant staff members to avoid confronting the challenge of learning about AT applications (Hutinger et al., 1996).

Assessment issues

Assessment of an individual’s AT needs and subsequent identification of appropriate equipment has been called by some researchers a process of ‘trial and error’ (Enders and Hall, 1990). It has been suggested that there are few guidelines available regarding the components of a competent AT assessment (Margolis and Goodman, 1999). The literature suggests that the deficiencies of AT assessment centre on two major factors: less than comprehensive assessment of individual needs and lack of team involvement in the assessment process. Vital aspects of the individual child’s abilities and needs may not receive due attention at the assessment stage. Service providers inexperienced in the assessment process are often primarily focused on obtaining a piece of equipment for the student’s use. Ascertaining the method by which the student can effectively access the device is sometimes considered as an afterthought, thereby increasing the chances of device abandonment (Todis and Walker, 1993; Cowan and Turner-Smith, 1999).

Criticism has been levelled at assessment that fails to investigate the impact of AT use within students’ daily physical and social environments. Factors such as where the technology will be placed, how it will integrate with other devices used by the student and environmental modifications required are often overlooked (Todis and Walker, 1993; Todis, 2001). This can be exacerbated when assessment occurs off-site rather than within the educational environment. Behrmann and Schepis (1994) compared three approaches to determining students’ AT needs when performing vocational tasks. The two approaches that involved situational assessment in the students’ natural environments, either in person or via videotapes, resulted in specific, functional AT recommendations. In contrast, the multidisciplinary approach that involved professionals conducting separate, standardized assessments in a rehabilitation facility tended to result in general recommendations and the need for further evaluation. These results suggest that considering technology needs within a functional context is a vital component of assessment.

One shortcoming of AT assessment that has received attention in the literature is that of inadequate team involvement in the assessment process. Todis and Walker (1993) found that staff members who are not included in the assessment process tended not to use the technology with the student as intended. It is therefore not surprising that occupational therapists reported poor teacher follow up of AT recommendations made primarily by the therapist (Reed and Kanny, 1993). Hutinger et al. (1996) similarly reported that lack of communication among school staff members contributed to limited integration of the technology into the student’s educational programme. Of equal concern is the lack of collaboration between the school and the home (Angelo et al., 1995). Despite family participation in services being mandated by legislation in the US, research has indicated that family factors are the least considered by teams when determining a child’s AT needs. Lack of consideration of the child’s own preferences is also apparent (Parette and Hourcade, 1997). Researchers have noted that failing to fully include the student and family in assessment and decision-making processes results in AT programmes which do not reflect family values and, hence, are not embraced by the family. Failing to incorporate user opinion and broader psychosocial factors into the assessment process is also associated with technology abandonment (Phillips and Zhao, 1993). Lund and Nygard (2003) found that the extent to which people used their assistive devices depended upon the contribution the device made to their occupational self-image. For parents of children with multiple disabilities, this may translate to whether the device fits the image they have, or wish others to have, of their child. At worst, lack of family input can lead to inappropriate prescription of technology, which dramatically increases family stress levels and impacts negatively on the student (Parette and Hourcade, 1997).

Planning issues

Beyond the process of assessing AT needs and acquiring the necessary equipment, careful planning of the way in which students will use AT to address their goals is critical. Studies that have tracked AT use by students with severe and multiple disabilities in their educational settings consistently reveal a lack of planning for successful implementation. Often, specific realistic outcomes for the student’s technology use have not been determined (Fuhrer et al., 2003). Frequently, no structured programme is put in place to allow the student regular, systematic use of technology in the classroom (Carey and Sale, 1994). This lack of integration is further evidenced by the limited mention of AT devices in students’ individual education programme (IEP) goals. An IEP is a summary of a student’s educational goals and the way in which the educational team proposes to achieve these goals. Even where IEP documents include AT use, there is seldom sufficient detail regarding how the technology should be applied to help achieve wider educational goals (Carey and Sale, 1994). Todis and Walker (1993) argued that if school staff were not aware of the purpose of the AT, training students to use devices became the long-term focus rather than a practical application to build on students’ academic and social skills.

Endless training in device use occurs at the expense of goal achievement (Todis, 2001). In Hutinger et al.’s (1996) study, no teachers nominated reciprocal communication as an objective for students’ technology use, even though the majority of students involved in the study were non-verbal. Problems with insufficient planning have an ongoing influence on students’ long-term service provision. Lack of follow up, review or re-evaluation after AT recommendations have occurred or technology plans have commenced is commonly reported and is associated with low rates of use (Scherer and McKee, 1990; Reed and Kanny, 1993; Cowan and Turner-Smith, 1999). In a study of 14 children over a two-year period, ongoing reassessment of AT needs did not occur unless initiated by an agency external to the school (Hutinger et al., 1996). This suggests that long-term planning and review of students’ AT needs is not an inherent feature of many school programmes and this omission limits the effectiveness of technology programmes that are implemented.

Funding issues

The high costs of AT devices and the lack of funds available to meet these costs were the most frequently mentioned barriers to AT use reported by teachers in Derer et al.’s (1996) study. Schools typically report access to fewer financial resources than they require to meet the technology needs of their students (Hutinger et al., 1994). Governments and private insurance companies vary considerably in terms of the type of equipment they will fund(Todis and Walker, 1993; Cowan and Turner-Smith, 1999). The cost of equipment maintenance is often not accounted for when AT is purchased (Cowan and Turner-Smith, 1999), even though additional costs are routinely incurred for evaluation, training in equipment use, repair of equipment, maintenance, replacement and customization (Noha, 1992).

Funding to expand or upgrade hardware and software as the child grows and changes must also be considered (Swinth and Case-Smith, 1993). These ‘hidden’ costs place a heavy burden on service providers to make decisions about appropriate technology systems prior to purchase (Swinth and Case-Smith, 1993). This task is made more difficult because the high cost of devices means that providers have less than ideal exposure to different devices and must therefore make these decisions on the basis of limited information (Higginbotham, 1993). To address these issues, equipment loan services have become available in some locations to allow trial of equipment at minimal cost prior to purchase. Two examples of this service are the Centralized Equipment Pool in Ontario, Canada and the trial equipment available from Regency Park Rehabilitation Engineering in South Australia (Hobbs, 2003).

Equipment issues

Problems reported in the literature in relation to AT equipment reflect difficulties accessing the equipment, criticism of the design and features of specific equipment, and problems in the use and maintenance of equipment. Difficulty locating and obtaining equipment is, like funding, considered a common barrier to achieving the promised benefits of AT for students (Derer et al.,1996). The assessment process is hampered by a lack of equipment for loan (McGregor and Pachuski, 1996) which may, in turn, discourage professionals from recommending devices for purchase (Reed and Kanny, 1993). Once equipment is ordered, a long wait may ensue before it arrives and is ready for student use (Carey and Sale, 1994; Cowan and Turner-Smith, 1999; Margolis and Goodman, 1999). In many schools, it is common practice for equipment to be shared between classrooms, which reduces its availability to individual children (Carey and Sale, 1994). The way in which individual schools store and manage equipment further determines accessibility of devices for spontaneous and functional use (e.g. ready access to allow communication with peers or teachers when desired) (Hutinger et al., 1996).

The design of an AT device may be a powerful determinant of its ongoing use by families and service providers. Lack of portability of equipment is a problematic factor frequently mentioned by consumers, carers and staff, as is the inflexibility of equipment that can only be used in a few settings (Scherer and McKee, 1990; McGregor and Pachuski, 1996; Priest and May, 2001). Further frustrations result from problems achieving compatibility among hardware and software (Beaver and Mann, 1994), limited adaptability of software for differing needs (Reed and Kanny, 1993; Todis, 2001), and equipment that is complex or operates at an unsuitable speed for the user (Scherer and McKee, 1990; Todis, 2001).

Difficulties with repair and maintenance of equipment are a constant source of frustration to users and service providers alike. When equipment breaks down, teachers report that students may be without their AT for months while it is returned to the manufacturer or supplier for repairs (Carey and Sale, 1994; Hutinger et al., 1996). This situation is compounded by the notable lack of in-school procedures and systems to register equipment faults and organize repairs (Hutinger et al., 1996). In a sample of 28 technology coordinators, less than half reported that they considered factors such as ease of equipment maintenance and repair to a great extent during AT assessment (Parette and Hourcade, 1997). Even day-to-day maintenance of devices which require a constant power source can be disruptive and time-consuming for teaching staff. Carey and Sale (1994) found examples of communication devices that had been taken out of use and stored in a cupboard when batteries had run out.

Time constraints

Given the difficulties already discussed with respect to obtaining and maintaining equipment and training in its use, it follows that time is at a premium for teachers and therapists who use AT with their students. The time required to obtain equipment, programme and install it, and train themselves and then students to apply the technology represents a significant barrier to teachers attempting to use AT to its full potential (Carey and Sale, 1994; Derer et al., 1996; McGregor and Pachuski, 1996). Further time is expended in moving equipment from one setting to another and determining the cause of equipment malfunctions (Carey and Sale, 1994). The unfortunate outcome is that some teachers cease to use devices because they perceive that these aspects of technology use do not fit into tight classroom schedules (Hutinger et al., 1994).

Overcoming barriers

Recognition of the problems encountered in the effective application of AT in schools has resulted in some practitioners developing and undertaking trials of systems and approaches to allow better delivery of AT services to meet individual needs. In addition, many researchers have proposed recommendations to circumvent the AT pitfalls identified in the literature. Apart from changes to funding mechanisms and equipment access and management, the range of solutions advanced can be grouped into two broad areas: training and support, and assessment and implementation of technology plans.

Training and support

Surveys of teachers and therapists, together with studies that have closely examined AT use in schools, have produced recommendations for training and support of families and service providers that cover a variety of needs (Todis and Walker, 1993; Carey and Sale, 1994; McGregor and Pachuski, 1996; Parette and Hourcade, 1997). A multi-faceted approach to training and support is deemed necessary (Derer et al., 1996), particularly in view of the range of knowledge and skills required. Knowledge with respect to disability, hardware and software, adaptive devices, systems for procuring equipment, design and construction of individualized equipment adaptations, and the settings in which the technology will be used is fundamental (Beaver and Mann, 1994). Competence in the application of this knowledge would therefore be a requirement of occupational therapists working in the field (Smith, 1992b).

The occupational therapist is just one member of the team involved in supporting AT. Strategies have been proposed to increase access to information about AT for all members of the team and include resources such as databases, newsletters, product reviews and evaluations of different devices (Noha, 1992; Higginbotham, 1993; Derer et al., 1996). Other suggestions that have recently been undergoing trials have involved establishing a toll-free telephone hotline, a peer support information network and local information and resource centres (Noha, 1992; Derer et al., 1996; Cowan and Turner-Smith, 1999; Doty and Gray, 1999; Margolis and Goodman, 1999). While these measures are considered useful, print resources have been rated of least importance to teachers (McGregor and Pachuski, 1996), who have cited more direct, organized training as preferable (Derer et al., 1996; McGregor and Pachuski, 1996).

Improvements to formal training programmes for service providers have further been proposed, including more specific AT course content for undergraduate and postgraduate occupational therapists and special educators (Kanny et al., 1991; Cramer, 1992; Smith, 1992a, 1992b), instructional units for teachers (Noha, 1992) and an accreditation or certification system for therapy teams (Smith, 1992a). One difficulty encountered in the quest for improvement of undergraduate training for special educators is the lack of consensus regarding the competencies necessary and the way in which these should be taught (Cramer, 1992; Lahm and Nickels, 1999).

Less formal continuing education options such as focused group training sessions and workshops are also sought (Parker et al., 1990; Reed and Kanny, 1993; Derer et al., 1996). Administrative support for these sessions, e.g. teacher release systems to allow attendance, is important to lessen the time demands for staff and encourage less confident teachers to participate (Derer et al., 1996; Hutinger et al., 1996).

Despite increasing attention to the training options available to service providers, it appears that organized training is not the complete answer to AT problems. A critical examination of AT use by teachers and occupational therapists reveals that a high level of formal training and/or continuing education does not necessarily correlate with better technology applications (Reed and Kanny, 1993; Hutinger et al., 1996; McGregor and Pachuski, 1996).

Highly trained teachers identify the need for more extensive training and ongoing support (Hutinger et al., 1996). Research suggests that this need extends to families and the students themselves, who rely on the skills of professionals (Phillips and Zhao, 1993; Todis and Walker, 1993; Carey and Sale, 1994; Parette and Hourcade, 1997; Margolis and Goodman, 1999). One-to-one consultation by a technology expert is often cited as a way of ensuring ongoing support. Consultants can either be on-site or conduct regular visits, and it has been deemed important that they are available for troubleshooting when the need arises (Parker et al., 1990; Reed and Kanny, 1993; Derer et al., 1996; Hutinger et al., 1996; McGregor and Pachuski, 1996; Scott, 1997). On the basis of experience with local technology resource persons, service providers stress that the value of consultants hinges on their readiness to provide support, their expert technical skills and their knowledge of the student (Carey and Sale, 1994; Hutinger et al., 1996).

Of equal importance is the type of support provided and the way in which this is delivered. Technology specialists often train one or two members of a student’s educational team, as the time required to train large numbers of staff in specific applications becomes prohibitive in the context of the specialist’s large caseload throughout the school or among different schools. The high attrition rate of teacher aides in particular means that there is a frequent need for training of new staff (Todis and Walker, 1993; OVEC, 2000).

In recognition of the need for integrating AT knowledge and skills within a team (Smith, 1992a), a different model of consultation, which features a technology team that is external to schools has undergone trials. It has been reported that such teams are successful because they have technical expertise and are able to focus purely on AT issues without needing to fulfil the other responsibilities of a typical educational team (Carey and Sale, 1994). However, the advantage of this model dissipates when team members leave. Even though technology expertise is spread among the team rather than concentrated in a single technology expert, this model still relies on the skills of a small number of people (Cowen, 1994). Some authors have therefore concluded that the availability of technology experts does not replace the need for all staff to have some level of knowledge and skills, a need that has been clearly demonstrated when students change schools (Cowen, 1994; Hutinger et al., 1996).

Technology projects recently piloted in the US have incorporated features including training teams within school districts in AT implementation, as well as providing ongoing support, technical assistance and regular follow-up (Doty and Gray, 1999; Nochajski et al., 1999; OVEC, 2000). The Reaching Individuals with Disabilities Early (RIDE) Project was conducted over a five year period. It involved using a series of training modules to provide local educational teams with the knowledge and skills to effectively address their students’ AT needs. In addition, technical support was provided to teachers, parents and children on demand within the school setting. Results indicate that the total length of time spent using AT per day increased significantly for children whose teams participated in the project (OVEC, 2000).

Assessment and implementation of technology plans

The literature supports the need for more effective ways of determining students’ needs, matching these with appropriate AT, and allowing more careful selection of equipment that is guided by forward planning of the student’s future needs (Parker et al., 1990; Higginbotham, 1993; Carey and Sale, 1994; Derer et al., 1996). To achieve this, educational teams need support to gather assessment data over an extended period of time (Carey and Sale, 1994), including observation of technology use in the settings in which it will be utilized (Behrmann and Schepis, 1994; Margolis and Goodman, 1999). Support is required to ensure that all team members have the opportunity to contribute to assessment (Todis and Walker, 1993; Nochajski et al., 1999;Fuhrer et al., 2003), and that perceptions of the student and family are investigated (Luborsky, 1993; Parette and Hourcade, 1997; Priest and May, 2001).

The classroom environment, together with time and other resources available to teachers, must be considered at the assessment stage so that the technology plan can be responsive to these issues (McGregor and Pachuski, 1996). Team members need assistance to identify the purpose and objectives of AT use and to incorporate these into specific IEP goals (Todis and Walker, 1993; Carey and Sale, 1994; Doty and Gray, 1999). Cramer (1992) confirmed that while special educators are trained to write measurable behavioural objectives, they may not receive instruction in how to incorporate AT into these objectives. Fuhrer et al. (2003) propose that conceptualizing the expected outcomes from use of a particular device is critical in determining whether individual users’ needs have been met.

To promote the effective use of technology, a detailed AT plan may be helpful. This plan could help to ensure that the student, teachers, parents, and peers are aware of the plan and their role in its implementation (Margolis and Goodman, 1999). Educational teams must then be assisted to modify the school programme to accommodate AT use (Cramer, 1992; Carey and Sale, 1994). This may involve setting timelines for systematically training the student in how to use the device appropriately, followed by regular practice (Carey and Sale, 1994). It is vital that AT use is incorporated into daily routines to support academic, social and personal goals (Cramer, 1992; Todis and Walker, 1993; Hutinger et al., 1996). Throughout implementation, specialist support should be requested as needed (Doty and Gray, 1999).

Finally, the team should also be guided to re-evaluate frequently the goals and technology plan (Todis and Walker, 1993; Margolis and Goodman, 1999). As the primary service providers, the educational team possesses much of the critical assessment information described above and is ultimately responsible for technology implementation. It follows that the team must be facilitated to drive the assessment and planning process (Behrmann and Schepis, 1994; Margolis and Goodman, 1999). Effective team functioning is seen as vital to achieve this task. It is likely, then, that educational teams require additional support and guidance to use an effective team process in the assessment, planning and implementation of students’ AT use. It would appear that an appropriate model for AT assessment and planning should involve a team assessment process that is conducted by the educational team and supported by a technology consultant. The consultant could facilitate team functioning (Shuster, 1993; Beaver and Mann, 1994; Hutinger et al., 1996), guide the assessment and goal setting process, co-ordinate family input and assist team members to create and implement a detailed AT plan. Expert technical support could be accessible to provide information about AT devices, assist in procuring equipment for trial, and to provide on-the-spot training and troubleshooting (Shuster, 1993; Margolis and Goodman, 1999).

Effective evaluation of such a model will help determine how educational and therapy resources can be directed so that AT use can facilitate better educational outcomes for children with multiple disabilities. In summary, the literature reviewed identified a number of issues as impacting on the current use of AT with children with multiple disabilities. Broadly, these issues relate to resources available to educational staff and the processes used to evaluate AT needs and implement plans. The way forward is the integration of team-based assessment and implementation, with clear identification of individual goals and provision of relevant supports and resources.

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Address correspondence to Jodie Copley, Division of Occupational Therapy, The University of Queensland, St. Lucia, 4072, Australia. Tel: 61 7-3365 3011, Fax: 61 7-3365 1622. E-mail: j.copley@uq.edu.au