Infants and Young Children Vol. 16, No. 4, pp. 272–283 c ... · Minkel Consulting, Windsor, NY (Ms Minkel). This work was supported by the National Institute on Disability and Rehabilitation

LWW/IYC AS213-01 August 11, 2003 8:31 Char Count= 0

Infants and Young ChildrenVol. 16, No. 4, pp. 272–283c© 2003 Lippincott Williams & Wilkins, Inc.

Integrating AssistiveTechnology Into anOutcome-Driven Modelof Service Delivery

Toby Long, PhD, PT; Larke Huang, PhD;Michelle Woodbridge, PhD; Maria Woolverton, BA;Jean Minkel, MA, PT

Infants and toddlers with disabilities and special health care needs (SHCN) have complex habil-itative and health care needs requiring multiple services throughout their lives. Providers of ser-vices to children underutilize assistive technology (AT) and AT services. This underutilization hasa significant impact on how well and how easily the children are integrated in home, school, andcommunity activities. The literature indicates that AT is appropriate when the device (a) is relatedto specific and clearly defined goals that are meaningful to the child and family; (b) takes intoconsideration practical constraints, such as the environment and funding resources; and (c) re-sults in the child achieving desired outcomes. Using an outcome-driven model this article outlinesa 10-step framework that can be used by service providers to guide them in determining the fitbetween the child’s needs and AT and/or AT services. Components of the framework and criticalinformation needed for decision-making at each step will be discussed. A family-centered, inter-disciplinary team philosophy is promoted. Key words: assistive technology, assistive technologyservices, decision-making, system of care, The Consortium Model

INFANTS and toddlers with disabilities andspecial health care needs (SHCN) have

complex habilitative and health care needsoften requiring a similarly complex array ofservices throughout their lives. Rehabilitativeservices and early intervention are increas-ingly available to children with disabilities and

From the Center for Child and Human Development,Georgetown University, Washington, DC (Drs Longand Huang and Ms Woolverton); Office of CampusOutreach Initiatives, the University of California,Santa Barbara, Calif (Dr Woodbridge); and theMinkel Consulting, Windsor, NY (Ms Minkel).

This work was supported by the National Instituteon Disability and Rehabilitation Research of theUS Department of Education under grant numberH133B001200 to the Consortium for Children andYouth with Disabilities and Special Health Care Needs.

Corresponding author: Toby Long, PhD, PT, Center forChild and Human Development, Georgetown Univer-sity, 3307 M St. NW, Suite 401, Washington, DC 20007(e-mail: [email protected]).

assistive technology (AT) is a critical compo-nent of this service array.

In spite of significant advances in AT andAT services, these interventions remain un-derutilized and poorly integrated into rehabil-itation plans for children with special healthcare needs. The objectives of this article areto first highlight some of the barriers to moreeffective utilization of AT and then provide aclinical decision-making framework that mayhelp providers incorporate AT and AT servicesinto a system of care for young children withdisabilities.

While the number of infants and toddlersusing AT has increased by approximately 60%since 1992, this is just a fraction of the num-ber of children receiving early interventionservices. Throughout the country only about7% of the children receiving early interven-tion services also receive AT or AT services(Technical Assistance Project, 2000). Under-utilization can affect the lives of the children,

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Integrating Assistive Technology Into Service Delivery 273

especially with respect to the ease in whichthey can be integrated into home and com-munity activities. In an effort to increase chil-dren’s use of AT, the reauthorization of theIndividuals with Disabilities Education Act(IDEA) (1997) required Individualized Educa-tion Program (IEP) and Individualized FamilyService Plan (IFSP) teams to consider each stu-dent’s need for AT and AT services at the timeof plan development.

Assistive technology is any product that isused to increase, maintain, or improve thefunctional capabilities of individuals with dis-abilities. Examples include items as simpleas a suction cup rattle as well as sophisti-cated computerized communication devices.Assistive technology services include the ser-vices and supports necessary to determinethe appropriate technology to meet an indi-vidual’s needs. Box 1 provides the legal defi-nition of AT and AT services. This definition isused by service providers, policy-makers, andregulatory bodies. The continual advances intechnology increase the likelihood that moreand more infants and toddlers with disabilitiescould benefit from assistive devices.

Guidelines for selection of AT have beenproposed to promote the appropriate con-sideration and use of AT. For example, oneset of guidelines proposed that AT is deemedappropriate when the device (a) is relatedto specific and clearly defined goals that are

Box 1. Definition of Assistive Technology and Assistive Technology Services∗

Assistive TechnologyAny item, piece of equipment, or product, whether acquired commercially, off the shelf, modified,

or customized, that is used to increase, maintain, or improve the functional capabilities ofindividuals with disabilities.

Assistive Technology ServicesThe evaluation of the needs of the child; purchasing, leasing, or otherwise acquiring a specific

device; selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, orreplacing specific devices; coordinating and using other services such as therapy, education,rehabilitation, and vocational training or technical assistance to the child, family, or caregivers inthe use of specific devices; and technical assistance or training for professionals or others whoprovide services to the child.

∗Technology-Related Assistance for Individuals with Disabilities Act (1988).

meaningful to the child and family; (b) iscompatible with practical constraints, suchas funding resources; and (c) results in thechild achieving desired outcomes (Judge &Parette, 1998). In order to provide appropri-ate AT services, providers need the skills andknowledge to address competently

• AT needs and the services to supportthem,

• Strategies and funding mechanisms to payfor the needed technology and services,

• A strategy for measuring child and familyoutcomes, and

• Family and contextual factors such as cul-ture, economic status, and geographicallocation and their impact on both atti-tudes toward and utilization of AT and ATservices.

While requirements for AT and AT serviceshave been legislated and guidelines for imple-mentation have been proposed, there are stillsignificant barriers to full utilization of AT andAT services. Some of these will be discussedbelow.

TRAINING IN AT

It is recognized that knowledge about ATand the services that support it is necessaryto develop a comprehensive AT system; how-ever, providers of services are not adequately


274 INFANTS AND YOUNG CHILDREN/OCTOBER–DECEMBER 2003

trained to identify, design, use, and teachchildren, families, and other caregiving per-sonnel to use assistive technology. Studies in-dicate that there is a shortage of professionalswho are adequately or appropriately trainedto provide AT or AT services to children(Lesar, 1998) or to serve children within an ATsystem of care. The need for more qualifiedservice providers has also been recognizedas well by families and children (Behrmann,1995).

Postprofessional training in AT is available;however, professional training in AT appearsto be limited. The Rehabilitation Engineer-ing Society of North America (RESNA) offersa Fundamental Assistive Technology Programfor any professional interested in becominga certified Assistive Technology Professional(ATP). There are also several graduate pro-grams throughout the country that concen-trate on AT for children. These programs,however, are highly specialized, attract a spe-cialized group of interested professionals, andhave little impact on the more typical train-ing of providers related to AT. Parette (1991)reported that 68% of respondents to an in-terdisciplinary survey had insufficient train-ing during professional preparation regardingAT and its applications. A multistate study onthe needs of school-based personnel indicatedthat 81% of providers feel their training needsin this area are not being met (Derer, Pols-grove, & Reith, 1996).

Few programs are available to provide anintegrated program of study related to AT.The federally funded Technical AssistanceProjects (Tech Act Projects) are potential re-sources to address training; however, thistraining is usually device-specific. State TechAct Projects offer a wide variety of coursesrelated to various devices (University of Col-orado Health Sciences Center, 1999; Univer-sity of Kentucky, 2002). These projects havea great potential to enhance provider skills,but they currently lack the cohesiveness toimpact the field broadly or to train “assis-tive technology specialists” who are avail-able as resources within an AT system ofcare.

DECISION-MAKING APPROACHESTO FOSTER USE OF AT

Over the last decade providers of earlyintervention, especially physical and occu-pational therapists, have embraced the con-cept of clinical decision-making (Campbell,1999) as a framework to design interven-tion plans for children with disabilities. Thereare several decision-making frameworks avail-able to help the practitioner develop interven-tion plans. Traditionally, the choice of ther-apeutic intervention has been made usingan impairment-oriented method of decision-making. In the impairment or deficit-orientedmethod, children are evaluated or assessed todetermine impairments or to identify develop-mental skills that they do not perform. Treat-ments are then chosen that either remediatethe impairment or facilitate the acquisitionof the skill (Lahm & Sizemore, 2002). Whenthis approach does not remediate the impair-ment, nor promote skill acquisition leadingto typical functioning, then the search beginsfor a device or system that compensates forthe lack of skill (Campbell & Forsyth, 1993;Kelligrew & Alien, 1996).

Contemporary models of decision-making support an outcome-driven system(Campbell, 1999; Campbell & Forsyth, 1993).In an outcome-driven system, interventionstrategies are developed to promote theattainment of the desired outcome andmaximize the skills of the individual (Cook &Hussey, 2002). For example, the HypothesisOriented Algorithm for Clinicians (HOAC)(Rothstein & Echternach, 1986) is a decision-making model used by physical therapists toguide treatment planning. HOAC is a 2-partprocedure. Part 1 utilizes 8 steps to guide atherapist in deciding treatment options basedon preestablished goals. Part 2 guides thetherapist to reassess the appropriateness ofthe strategies chosen to meet the specificgoal. In outcome-driven models compen-satory strategies such as AT are not invokedonly when remediation and facilitationstrategies are unsuccessful, but are givenequal priority in the treatment planning.



Intervention strategies, including technology,are determined within the context of thetask demand in an outcome-driven approach.Unfortunately, providers lack training in thismodel of decision-making and its relevanceto AT and AT services (Campbell, 1999).

CONTEMPORARY FUNDINGCHALLENGES

Service systems for children with disabili-ties are complex, involving multiple programswith differing eligibility criteria, differentfunding sources, and different purposes. Chil-dren within the same programs may have ser-vices funded by different payers (Bronheim,Magrab, & Striffler, 1998). This complexityapplies to AT services as well. Understand-ing the complexity of the services systemsinvolved with children with disabilities andspecial health care needs is critical in makingsound decisions that have a meaningful im-pact on the lives of children with disabilitiesand their families. Specifically, providers needthe knowledge regarding funding to assurethat AT-related plans can be implemented, yetmany currently lack this knowledge and thereare few training programs available that focuson these issues (Judge & Parette, 1998). Forexample, many children who receive physi-cal therapy are insured by Medicaid. Most chil-dren with disabilities and special health careneeds receive physical therapy under IDEA. Itis imperative that therapists understand theresponsibilities of the Medicaid system, theearly intervention system, and/or the educa-tional system, and how these systems interre-late regarding funding of AT and AT services.

KNOWLEDGE OF FAMILY CONTEXTAND NEEDS

Providers must have knowledge and skillsto understand the context within which ATwill be used. This type of knowledge can onlybe obtained through input from consumersand families in planning the need, use, andbenefits of AT (Parette & Brotherson, 1996).The last 15 years have given rise to the ad-

vent of person-centered and family-centeredcare for individuals with disabilities. Althoughmany therapists share information with fam-ilies and gather information from families,few collaborate equally with families in de-ciding treatment strategies, including AT, ser-vice delivery models, or necessary adjuncts totherapeutic intervention. Given the emphasison family participation in early interventionit is imperative that providers consider fam-ily issues, concerns, needs, and preferencesin making decisions regarding AT and ATservices.

KNOWLEDGE OF STRATEGIESTO ASSESS AT NEEDS

The requirements of the IDEA have encour-aged therapists and other providers of AT toexamine the procedures specifically used toassess and determine AT needs of children.There are several assessment tools/strategiesthat are available to therapists to assist themin decision-making regarding AT. Table 1 pro-vides salient information on 3 tools commonlyused by AT professionals.

The use of these assessment approaches as-sists teams in making decisions on specific de-vices, strategies, or services once it is recog-nized that a specific AT device or AT servicewould be beneficial. Because of the complex-ity of AT and AT services, a broader frame-work is needed to ensure that these client-specific models can be implemented and theinformation gathered can be used effectively.A model that outlines all the steps involvedin the process will increase the likelihoodthat therapists and other early interventionproviders will be comfortable in addressingthe AT needs of the youngsters and planningappropriately to meet those needs.

THE CONSORTIUM∗ MODEL

The Consortium Model presented hereis a 10-step procedure designed to guide

∗The Consortium for Children and Youth with Disabilitiesand Special health Care Needs.



Table 1. Assistive technology (AT) assessment models

Name Author Purpose

Education Tech Points Bowser and Reed(1995)

Questions related to AT used by professionals atvarious points in the assessment process tohelp teams effectively select AT and implementAT services

The Student, theEnvironment, theTasks, and the Tools(SETT)

Zabala (1995) This is a collaborative process assisting teams inbuilding consensus regarding the child’s needfor AT, the type needed, and the interventionsneeded to support the AT

Matching Person andTechnology

Institute forMatching Personand Technology(2002)

A user-driven and person-centered process usedto match individual with technologies. This isactually a series of questionnaires that considerthe environment, the users’ preferences, andthe functions and features of the AT

Human, Activity,Assistive Technology(HAAT)

Cook and Hussey(2002)

The model takes into consideration the skills ofthe individual, the task that the person isexpected to perform, and the context orconstraints on the activity

therapists through a series of actions and de-cisions regarding AT (see Fig 1) and addressessome of the barriers described earlier. Mostproviders are unprepared to participate fullyin team decision-making regarding AT withinearly intervention or special education. Thismodel operationalizes, for the provider, thespecific steps needing decisions regardingAT and AT services and the information andpersonnel to be considered at each step(Table 2).

This model is based on the principles ofoutcome-driven decision-making and the be-lief that AT is a strategy to foster indepen-dence. Outcome-driven decision-making re-quires providers to make recommendationsfor AT and AT services based on what the fam-ily and team would like the child to accom-plish within a set amount of time. To accom-plish these outcomes, teams must design ATand AT service plans that address the barrierspreventing achievement of the desired out-comes and the opportunities promoting theachievement of the outcomes in addition toremediating impairments.

As the developmental needs of the childchange, providers must revisit the desired out-

comes and reconsider a full range of inter-vention strategies and services. Contempo-rary practice promotes the use of AT as astrategy to increase independence and pro-mote the acquisition of functional and de-velopmental skills in addition to overcomingdisabilities. This deviates from the traditionalapproach of using AT as a remediation ef-fort. Identification of AT options and the in-tegration of the technology into everydayactivities is a time-consuming process re-quiring collaboration and cooperation amongmany people. Providers can facilitate collabo-ration and cooperation by understanding theprocess.

Step 1: Recognition of a problem

Family members, caregivers, or pediatri-cians are usually the first to recognize that aninfant or toddler may be having difficulty inperforming developmental tasks or functionalactivities and may refer the child to a devel-opmental specialist or an early interventionprogram for a comprehensive evaluation todetermine eligibility for services and the de-termination of type of services.



Fig 1. The Consortium Model.

Step 2: Evaluation and outcomedetermination

A comprehensive evaluation will delineatethe overall developmental level of the childand provide a differential diagnosis if possi-ble. In early intervention an IFSP will be de-veloped with the family to determine family-centered outcomes and the services to meetthose outcomes. Traditionally, services suchas physical therapy or occupational therapyare identified and referrals are made to thoseproviders to initiate intervention.

In an outcome-driven model the full rangeof services, which can facilitate the child’stimely achievement of the desired outcomes,will be identified at this time. Because tech-nology is benefiting younger and younger chil-dren, the evaluation of AT and AT servicesmust be considered as a service to assist thechild to meet the family-centered outcomes

identified during the IFSP meeting. Assistivetechnology should be regarded as one of manystrategies available to meet developmentaland functional outcomes. The desired func-tional outcome, not the age or developmentallevel, will guide the team in deciding if AT orAT services would be appropriate.

Step 3: Assessment/identificationof AT and AT services

There are technology options to assist achild in many activities: communication, mo-bility, positioning and seating, activities ofdaily living, recreation, and problem-solving.In a contemporary, outcome-driven decision-making approach AT and AT services are con-sidered to be components of this planningstep. It may be necessary to refer the child toexperienced providers of AT as it is likely thatthe early intervention providers do not have



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the skill to assess comprehensively AT needs.Community-based AT providers may includeoccupational therapists, physical therapists,special educators, speech-language patholo-gists, etc. There are also specialists, ATPs, whohave been certified by the RESNA, who maybe available to assist the team. Additionally,each state has a federally funded program, theTech Act Project (www.ataporg.org) that isavailable to identify where AT assessment ser-vices can be found, if the local team feels illprepared to conduct an assessment. At thisstep, however, it is imperative that the non-AT specialist provider be aware that AT andAT services are available and could be helpfulin assisting the team in meeting the outcomes.As the outcome-driven model becomes morecommonplace, providers will be forced to be-come more familiar with the variety of treat-ment options including AT and will developcollaborative relationships with community-based AT providers.

At this point the AT specialists may aug-ment existing data about the child’s needswith data specific to AT by using one of theevaluation tools mentioned previously (seeTable 1). For example, the SETT (Student, En-vironment, Task and Tools) provides a struc-ture around which the child’s current func-tional skills, the tasks the child wants/needsto accomplish, the environments in which thechild would like/needs to participate in, andthe tools (AT devices/services) that may bepotentially useful can be discussed and doc-umented (Zabala, 1995).

Step 4: Develop an AT menu

Assistive technology is any device used toincrease, maintain, or improve functional abil-ities. Some devices are “low” tech and read-ily available at Toys “R” Us, Wal-Mart, andother discount stores. Other “high” tech op-tions are available through more specializedsuppliers. Electronic communication, espe-cially through the Internet, has greatly in-creased the availability of information abouta whole array of AT products. For example,Abledata (www.abledata.com) is a nationalonline database listing a wide variety of ATproducts. Prior to searching out specific de-

vices, it is imperative that the team developsa list or menu of possible devices and servicesthat would assist in promoting the outcomesdeveloped. This menu will be used to matcha specific device(s) to the child’s individualneeds and family circumstances.

Step 5: Match AT and AT services tothe child and family needs

This step is often time-consuming. Prior topurchasing a device it is important to includea trial period with one or more products fromthe menu developed in Step 4. This trial pe-riod is critical in determining which productwill best meet the child’s individual needs andbe accepted by the family. Some technologiesmay need to be used for a period of time be-fore the team (including the child and fam-ily) can determine the actual usefulness ofthe tool. For some children it may be neces-sary to try a variety of devices or services.Each experience needs to be carefully eval-uated with regard to the likelihood that theparticular product will assist the child in ac-complishing the outcome. There are severalinterrelated factors that must be consideredin the selection of the device: child charac-teristics, family issues, the task and the con-text and environment in which it will takeplace, technology features, and service sys-tem issues. Ruling out a device during a trialperiod is a much more cost-effective step thanabandoning a purchased product because itdid not actually meet the child’s need. Fail-ure to take the time at this point will increasethe likelihood of abandonment of the AT de-vice. Abandonment of an AT device has beenshown to (a) exacerbate the effects of thedisability on the child, (b) increase financialburden on families, and (c) tax the limited re-sources of the service system (Parette, Van-Biervliet, & Hourcade, 2000). As part of anoutcome-driven model, to determine the ben-efit of a device, it is important to assess thedevice within the environment that it will beused. It has been demonstrated that the rec-ommendations on AT and AT services becomemore inadequate or inappropriate the furtherremoved the assessment takes place from theenvironment in which the device is to be used

http://www.ataporg.org

http://www.abledata.com



(Behrmann & Schepis, 1994). This approachincreases the likelihood of abandonment.

Step 6: Select a device and identifyAT services

Once all the options have been reviewedand undergone a trial period, the specific de-vice is selected and the training needs of thechild, family, and other care providers in re-lation to the device are outlined. The mostcommon reason for abandonment of an ATdevice is lack of training on how to appro-priately use the device and integrate it intoeveryday activities (Parette et al., 2000). A va-riety of people must be trained: child, fam-ily, other caregivers, teachers, etc. The im-portance of an individualized plan delineatingthe frequency of training for each trainee andthe strategies that will be employed cannot bestressed enough. In order for the device to beuseful, training must take place in naturally oc-curring activities and routines. It has also beenshown that different audiences prefer differ-ing methods of training. For example, Parette,Brotherson, Hourcade, and Bradley (1996) re-ported that families prefer to receive informa-tion and training from users of the technology,in particular, other families who have childrenwith similar disabilities and AT experiences.They also prefer demonstrations and informa-tion tailored to their needs.

Step 7: Identification of a supplier

Although this step is closely aligned withStep 6, the decision on which supplier of adevice will be chosen should be made follow-ing the selection of the device. Following aperiod of trial use, the team can make a rec-ommendation for a specific product. As notedearlier, some products are readily available atlocal commercial retailers. A large number ofmobility aids and feeding/eating aids can befound in children’s stores or catalogues to ad-dress the needs of infants and toddlers. Fre-quently, these baby products (strollers, carseats, feeding dishes, etc) are significantly lessexpensive than similar products marketed asAT devices. Very often, minimal modificationscan make a high chair or a Magic Marker veryfunctional for a child with a disability.

For products which were designed specif-ically to meet the needs of children with adisability, sale and distribution may only bethrough specific suppliers. Suppliers shouldbe knowledgeable in the advantages and dis-advantages of a variety of devices, not justthe devices they are authorized to sell anddistribute. They should have a proven trackrecord with working with therapists. Providerteams should develop collaborative relation-ships with a variety of vendors or suppliersof equipment. Oftentimes therapists or othercare providers allow the vendor to influencedecisions regarding types and features of ATbecause they feel unknowledgeable. It is im-portant that AT selection is closely linkedto the outcome that is desired. If decision-making is primarily left to the supplier there isthe risk that the decision will be made solelyon the availability of funding, the child’s diag-nosis, and the impairments of the child (Lahm& Sizemore, 2002). Individual suppliers are of-ten knowledgeable in a specific type of tech-nology and thus, they may base decisions onlyon what they are familiar with and not the fullrange of products available (Lahm & Sizemore,2002). Lahm and Sizemore (2002) also notethat finances often drive a supplier’s choiceof a device. In an outcome-driven decision-making model it is imperative that decisionsare based on desired outcomes for the child.

Because many devices are highly sophisti-cated, careful attention should be given tovendors who also provide maintenance andteach caregivers basic maintenance and carefor the equipment. No matter how successfulthe child is with a particular piece of technol-ogy, if the device is not in working order, itwill not be useful to the child. Reliability andaccessibility are 2 key features that a vendorof AT devices should possess.

Step 8: Identify a funding source

Funding can present a major barrier to ac-cessing AT. There are 4 factors that impactidentifying a funding source: (a) the highcost of the equipment, (b) vague or con-flicting eligibility criteria imposed by fund-ing sources, (c) professionals’ lack of knowl-edge, and (d) difficulty accessing third party



payment sources (Judge & Parette, 1998). Al-though these present a great challenge, all toooften funding issues are used to guide clinicaldecision-making. These are 2 separate issues.Funding is a matter of resource allocation.Outcome-driven decision-making focuses onwhat the child needs to complete successfullya specific task or outcome. When identifyingthe funding source, it is important to identifythe cost of the product, and identify the costsassociated with training. All too often devicesare poorly integrated into a child’s daily activ-ities because of a lack of training and ongoingsupport for both the child and for other teammembers.

Many service providers immediatelyconsider the “third party payment require-ments,”medical insurance, and school districtor agency purchasing regulations, before amatch between product and need has beenmade. When the issue is resource allocation,parents, families, and all team membersshould, initially, be educated on all the avail-able technology options, and then decidehow resources are best allocated to meetthe child’s needs. Resource allocation caninclude the family’s decision to use privatefunds to purchase the product directly. Inmany situations, a discounted price and amuch more timely delivery of the productcan be arranged when private funds are beingused for a “direct sale.” In some instances,a cost-sharing model is used, using privatemedical insurance for a mobility aid for exam-ple. There are government funding programs,Medicaid for example, which will pay for“medically necessary” AT. If intended to meeta child’s educational needs, the technologyand related services need to be written intothe child’s IEP to secure district funding.

At least one member on the team needsto take the lead on identifying and securingfunding. When resources, other than privatefunds, are being used, an understanding of thefunding system’s requirements is essential.A system of tracking paperwork, signatures,dates, and decisions made can prove to be in-valuable as the request makes its way throughthe system. Each State’s Tech Act Projectmay prove invaluable advocating for fund-

ing and developing an information trackingsystem.

Step 9: Implementation

The process of identifying and selecting ATis extremely time-consuming. On the day aspecific product is finally delivered, many onthe team may feel they have reached the con-clusion of the process. However, if the childis to be truly successful using the technology,the delivery day actually marks just the begin-ning. Ultimately, implementation should bethe seamless use of the product by the childto complete the desired activities. To achievethis end, however, implementation must be-gin with training for the child and family onhow to use the specific product. In somecases this training will be of fairly short du-ration, for example, instructing the family onhow to fold a wheelchair for transportationin their car. Other training needs are slightlylonger, eg, teaching mobility skills in both in-door and outdoor environments. Still othersmay involve initially intensive training with anongoing need for support and modification,as the child’s needs change, along with the in-creased use of and facility with the product,such as in the case of an augmentative com-munication system for expressive communi-cation needs.

Teams using the outcome-driven approachshould have clearly defined and measurablegoals to monitor progress throughout theimplementation phase. Teams who have in-vested the time and effort to clearly iden-tify mutually agreeable outcomes, taken ad-vantage of product trials, and outlined thetraining needs, should be able to monitor thechild’sprogress toward attaining the expectedoutcomes. There will still be times when thedevice or the training will need to be modifiedto improve the outcome. However, clearly de-fined outcomes and careful follow-up and as-sessment of use of the product will providethe evidence that AT and AT services are ben-efiting the child.

Step 10: Follow-up

An essential element of any thorough in-tervention plan is follow-up or continuous



quality improvement. To avoid negative con-sequences of using AT, the team must takethe time to obtain continuous feedback fromthe technology users. Ongoing input fromfamilies and, as appropriate, the child, willdecrease the likelihood of underutilization orabandonment. This process will also identifythe successful use of the device or service,validating the team’s original plan. Addition-ally, as the child successfully uses the tech-nology other needs may become evident re-quiring adaptation of the device or additionaltraining in its use. Although the child and fam-ily are the most important sources of informa-tion regarding the success of the AT and ATservice, other team members may also pro-vide important feedback. Assistive technologymay help the child to be more integrated intothe community, more independent, more cu-rious, and more functional. As a result, careproviders and therapists may need to tailortheir interactions and/or treatment strategiesto meet the child’s changing needs or de-mands. They may need additional training orsupport to ensure appropriate utilization ofthe device. Additionally, ongoing informationand feedback from the AT vendor and/or ser-vice representative should be sought. Whenthe desired outcome is not achieved, the en-tire team should learn from the experience.Therapists and providers need to listen to andobserve the child carefully to identify the is-sues that may be preventing a successful out-

come. If the product is helping in accomplish-ing the task the child may use the product;conversely, if the product does not enable thechild it will not be used.

CONCLUSION

An outcome-driven model of decision-making provides the opportunity for the fam-ily and service providers to design a planof care using a variety of interventions toachieve the desired outcome. Assistive tech-nology is a currently underutilized interven-tion by many providers. This article has de-scribed a model designed to assist providerteams in understanding the various decision-making steps to secure AT and AT servicesfor young children with disabilities and spe-cial health care needs. Through collaborationamong team members, children, and families,the identification, implementation, and uti-lization of AT devices and AT services mayfacilitate and promote attainment of specificfunctional outcomes for the children. Care-ful monitoring of progress toward the desiredoutcomes is essential throughout the process,which stresses trial use of products, identifi-cation of specific devices to meet the need,securing funding, and the immediate and on-going training needs to facilitate seamless useof the technology to complete the functionalactivity.

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Infants and Young Children Vol. 16, No. 4, pp. 272–283 c ... · Minkel Consulting, Windsor, NY (Ms Minkel). This work was supported by the National Institute on Disability and Rehabilitation