Assistive Technology in Early Intervention

A preschool age girl with a prosthetic leg is at a medical appointment. The child is meeting with her physical therapist. The child is sitting on the floor building with wooden toy blocks. The medical professional is sitting on the floor assisting the girl.

Posted in Disability Early Childhood Intervention Policy  |  Tagged , , ,

by Sharice Lane, SLP, M, January 16, 2018

Sydney is a toddler who lives at home with her parents. She receives daily care from her immediate and extended family members (i.e., grandparents, aunts, and cousins). Sydney has a diagnosis of cerebral palsy and attends her local Early Intervention program. She receives physical and occupational therapy. As she aged, her service providers became concerned with her motor skill development, especially her difficulty in learning to stand and walk. At the age of 18 months, the Individual Family Service Plan (IFSP) team agreed to include assistive technology to promote standing and walking in her home and childcare center. Although Sydney’s family agreed to the use of assistive technology (AT), for some families, AT is a novel concept that takes time to learn, use, and advocate its functional importance across routine based activities.

Family and caregivers of children with disabilities may see multiple barriers that effect the child’s development, compared to typically developing children. Kang et al (2017) discuss the environmental, social, and attitudinal barriers many families and caregivers of children with disabilities report face compared to families and caregivers of children without disabilities. Families identify lack of resources, equipment, training, and inclusivity that hinder their child’s development compared to children without disabilities. Environmental knowledge (i.e., resources, coaching/training, family support, etc.) can help families of children with disabilities to feel included in their community and promote the overall well-being of their child’s development (Kang et al, 2017). AT devices and strategies are crucial components that help caregivers include children in routine-based activities across a variety of environments. Sydney and her family were more easily included in community based activities by using AT.

Many young children and their families depend upon AT resources and services to promote function across routine activities and environments. Children with disabilities or delays use AT to access their environment so they can move, play, and communicate safely and effectively. The Individuals with Disabilities Act (IDEA) defines AT “as any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a children with a disability (§602(1), 2004).” IDEA (§602(2), 2004) specifically distinguishes AT services from AT devices and defines AT services as “any service that directly assists a child with a disability in the selection; acquisition, or use of an assistive technology device. This definition highlights that for children and families similar to Sydney’s, AT can be a specific device or a service that is provided to train families to use and maintain the device in order to use it across activities and ensuring that the families have many opportunities to implement learned strategies.

The IFSP team meets to discuss the need for including AT devices and services in the plan to accomplish family-centered outcomes. The team, which always includes the family, considers the implications for AT use to facilitate effective child involvement in routine-based activities. Sydney’s family and the rest of the IFSP team discuss multiple factors that can affect the success of using the device. Factors such as the persons who Sydney will be interact with, the activities she will be involved in, the environments in which she will use the device, and what types of technology are available all contribute to the decision making process.

Also, to assist with decision-making there are four questions that the IFSP team should answer: (https://www.teachingei.org/technology/11-consider.php):

1. Have previous interventions, modifications, and strategies not led to the functional results desired by the team; 2. Has there been a change in environment or circumstance; 3. Has the child’s skills or behavior changed; 4. Is there a change in technology (e.g., compatibility issues)?

The Student, Environments, Tasks, and Tools (SETT) framework (Zabala, 2010), is used by the IFSP team to consider all aspects of AT decision-making, helping the team make the most efficient, effective and functional recommendations for the device and services ensuring that the child and family will use the device across environments and by many caregivers. This eight-step decision-making process accounts for the interconnections among the: 1) child, 2) environments, 3) tasks, 4) tools, and the need for 5) ongoing evaluation and modification. Dunst, et al (2013) concluded in his meta-analysis that AT devices “promoted child engagement” in routines (e.g., playing with toys, self-feeding, moving around the home) that may otherwise be very difficult or impossible to achieve. AT devices were shown to positively impact the attainment of outcomes regardless of age, disability, or severity of child’s intellectual delay (Dunst, et. al, 2013). AT devices and strategies that are designed in light of family-centered outcomes promote multiple opportunities for the child to achieve success.

  1. Collect Child and Family Information
  2. Examine Natural Environments
  3. Identify Elements of Key Activities
  4. Brainstorm AT Solutions
  5. Create an Implementation Plan
  6. Modifications + Recommendations

Sydney’s family and service providers collaborate with each other to ensure ease of device use and activity implementation. Unfortunately, studies indicate many families and service providers “abandon” AT devices and strategies after initial implementation.

Common pitfalls an IFSP team must consider to mitigate abandonment of the device include:

1. Limited access to Early Intervention specific AT implementation strategies (i.e., routine-based intervention, least intrusive device/strategy across environments, etc.) 2. Lack of evidence-based practices implemented by service providers and family members when using IFSP defined AT devices and/or services; 3. Limited consideration of ongoing AT device maintenance or strategy modification as the child ages or family circumstances change.

Recent studies have demonstrated the necessary attitudinal shifts of parents and caregivers occur when provided sufficient and effective coaching to implement AT devices and strategies across environments and daily activities. Tamakloe and Agbenyega (2017) concluded that outcomes were achieved when childcare center teachers and staff used AT devices and strategies. Based on a survey that questioned the staff’s interactions with AT, the authors concluded that ‘maintaining positive attitudes’ were paramount for learning, maintaining, and modifying AT device usage of children with disabilities in the classroom. Service providers must provide optimal training and coaching in how to incorporate AT devices in routine based activities. Nelson, et al (2013) reported, based on interviews with teachers about their perceptions of AT use in the classroom, that teachers must know when technology will be beneficial in the classroom, as well as counterproductive to a child’s learning. Both low and high tech devices are appropriate for use by young children in the classroom, home, and community. Children use low-tech device to participate successfully in routine-based activities in the classroom and community.

Sydney’s family and service providers collaborated, coordinated, and executed an IFSP to include AT device(s) and strategies to address the family-centered outcomes. The family received coaching and training on how best to incorporate these devices in their daily activities to support Sydney’s motor skill development. The family and service providers coached and trained Sydney’s childcare center staff to ensure the AT devices and strategies were frequently and effectively included in the classroom’s daily routine. Providing the equipment, resources, and skills can help resolve environmental, social, and attitudinal barriers that would impede Sydney’s overall development.

References

  1. Dunst, C.J., Trivette, C.M., Hamby, D.W. (2013). Systematic review of studies promoting the use of assistive technology devices by young children with disabilities. Research Brief Volume 2, Number 1. Tots-n-Tech Research Institute.
  2. Kang, L., Ming-Chieh, H., Liao, H.F., Hwang, A.W. (2017). Environmental Barriers to Participation of Preschool Children with and without Physical Disabilities. International Journal of Environmental Research and Public Health. 14:518. Retrieved from: http://www.mdpi.com/journal.ijerph
  3. Nelson, L.H., Poole, B., Munoz, K. (2013). Preschool Teachers’ Perception and Use of Hearing Assistive Technology in Educational Settings. Language, Speech, and Hearing in Schools. 44. pps. 239-251.
  4. Sawyer, B., Milbourne, S., Dugan, L., Campbell, P. (2005). Report of assistive technology training for providers and families of children in Early Intervention. Research Brief Volume 2, Number 1. Tots-n-Tech Research Institute.
  5. Simpson, L.A., Oh, K. (2013). Using Circle Time Books to Increase Participation in the Morning Circle Routine. Teaching Exceptional Children. 45; 6, pp. 30-36.
  6. Tamakloe, D., Agbenyega, J.S. (2017). Exploring preschool teachers’ and support staff’s use an experiences of assistive technology with children with disabilities. Australasian Journal of Early Childhood. 42:2. Retrieved from: http://dx.doi.org/10.23965/AJEC.42.2.04
  7. Zabala, J. (2010). The SETT Framework: Straight from the Horse’s Mouth. Retrieved on 2 January 2018 at http://www.joyzabala.com/uploads/CA_Kananaskis__SETT_Horses_Mouth.pdf
  8. http://ectacenter.org/~pdfs/decrp/PG_Env_LearningWithinReach_print.pdf
  9. https://www.teachingei.org/technology/01-overview.php
  10. http://www.techfortykes.org/ifsp/decision_tree.htm

Sharice Lane, SLP, M
Early Intervention Diversity Fellow, 2017-2018