Article reviewed:
Chmiliar L. Perspectives on assistive technology: What teachers, health professionals, and speech and language pathologists have to say. Developmental Disabilities Bulletin 2007;35(1 & 2):1-17.
Question # 1. In your view, what interesting similarities and differences are found among the three groups of professionals surveyed?
The difference in funding sources for assistive technology (AT) indicated by each respondent group was interesting, but not unexpected. For instance, I would expect teachers would observe AT funding for students being accessed primarily via school/district resources; whereas speech pathologists and health care professionals, whose practices may include children and adults, would be more likely to observe funding being accessed through government programs and community organizations, respectively. (I was surprised that insurance was not indicated as a primary source for AT funding by the speech pathologist and health provider groups in particular. I expected insurance to have been more prevalent than it was as an identified funding source in this survey.)
The differences between the groups’ responses regarding funding sources suggests a lack of continuity in funding source(s), resource availability, resource access, and perhaps even eligibility and equity, after individuals leave the elementary/secondary school system. I appreciated the author’s recommendations of a centralized funding source (such as government funding) and of equipment sharing programs. A consistent, centralized funding source for AT, as well as improve availability of equipment and more equitable access to equipment, could do a great deal to support lifelong learning and continuing professional development for individuals who have special needs after they leave the elementary and secondary school systems.
I am interested to know the proportion of respondents in the teacher group who practiced in rural vs. urban areas. This descriptive demographic information was included for the speech pathologist and health provider groups, but not the teacher group. For the speech pathologist and health provider groups, 50% and 71%, respectively, indicated they practiced in urban areas. A regression analysis identifying correlations between urban/rural location and training opportunities, training sources/modes, self-reported skill level and satisfaction with AT skills within and amongst the three respondent groups may yield critical information regarding existing gaps and where/how support/policies/initiatives could be effectively targeted.
(It would have been interesting to have invited occupational therapists and physical therapists to complete the survey, as well.)
The data seemed to suggest a correlation between training (pre-service and/or continuing professional development), current level of satisfaction with AT skills and knowledge, and satisfaction with current levels of AT skills and knowledge. Teachers, 70% of whom indicated they had had no opportunity for in-service or prior coursework in AT, also indicated the highest levels of dissatisfaction with current skill level (86% either somewhat or very dissatisfied), and the lowest levels of self-reported current skill level (76% unskilled or needing support). This indicates an important potential area for improvement, especially considering the importance of teachers as part of the multidisciplinary AT assessment and implementation support team. As the author recommends, increased access to experts as well as training opportunities and supports may significantly improve teachers’ skills and knowledge and satisfaction with their skills and knowledge.
For speech pathologists, while 97% indicated they had undertaken AT coursework at the undergraduate level, only 50% indicated they were unskilled or needed support, but interestingly 72% (compared to 76% for teachers and 69% for health professionals) indicated they were somewhat or very dissatisfied with their current skill level and knowledge. This may reflect a common feeling of not being able to adequately meet the needs of their clients with currently available AT, amongst a group of experts who work directly with clients to implement AT and who have a deep understanding of their clients’ needs and of what supports might be more useful in meeting these needs. This implication is supported by the speech pathologists’ rating availability of equipment as the second highest strategy for AT implementation, behind funding. Health professionals also rated equipment availability as the second most important strategy, behind funding.
All respondent groups indicated funding as the most important strategy for supporting AT implementation, reflecting a consensus amongst multidisciplinary teams with respect to the most pressing issue needing to be addressed.
For the funding accessed via community organizations and school district sources, I would be curious to learn in greater detail where the funding originated. Was it special funding that came from a government initiative, such as Alberta Education’s Innovative Classrooms initiative (2008-2011) (see: http://education.alberta.ca/admin/technology/classrooms.aspx)? Or, for community organizations, a portion may be from philanthropy. In any case, the point is that direct government funding is not readily available. (Chmiliar, 2007)
Funding also impacts equipment availability, which the clinical professionals indicated as the second most important strategy for AT implementation. In contrast, equipment availability was less of a priority for teachers, who indicated the lowest levels of pre-service or continuing professional development; for teachers, time for training was the second most important strategy for supporting them with AT implementation, which would improve their ability to contribute as members of multidisciplinary teams in identifying and serving their students’ needs. A second article, co-authored by Chmiliar, in the same issue of the journal, further identify explores the lack of pre-service training as a correlate to teachers’s perceptions about their AT skills and knowledge and needing assistance in the classroom, and explores the development of the Athabasca University course PSYC 476/576 in response. (Chmiliar & Cheung, 2007).
All respondent groups indicated time to set up and program AT equipment and time for training lacking, which suggests an area that should be targeted for support/improvement.
Overall, I think the most promising impression I take away from this article is that the results for each group in terms of satisfaction level with current skills and knowledge indicated a strong desire across all the groups to pursue training and professional development to help improve their respective practices. This suggests all groups would be receptive to initiatives aimed at supporting their training and professional development.
Question # 2. From this data, what barriers must be addressed in Alberta to provide better service to individuals with special needs?
Practitioner surveys like this (Chmiliar, 2007) are very important for identifying resource gaps, etc., and informing policies and initiatives to address these.
As I mentioned in my answer for question #1, a regression analysis identifying correlations between urban/rural location and training opportunities, training sources/modes, self-reported skill level and satisfaction with AT skills within and amongst the three respondent groups may yield critical information regarding existing gaps and where/how support/policies/initiatives could be effectively targeted. Having included occupational therapists and physical therapists in this survey may have also yielded meaningful information.
The three groups were consistent in identifying the following factors as barriers to assistive technology (AT) implementation and providing better service to individuals with special needs:
- Expense of AT / Funding
- Time to become proficient
- Lack of available AT
- Availability and support to program AT
With respect to multidisciplinary teams, the most significant barrier appears to be lack of pre-service training and professional development for teachers that would allow to contribute more meaningfully to AT needs assessments and implementation. This could be addressed by adding a requirement to complete a specific AT course as part of an education degree, or by adding a requirement for AT training as part of teachers’ professional development plans to maintain their certification. Some pre-service teachers may gain AT experience through their professional terms (as a student teacher in a classroom), but this exposure would not be consistent. Some standardization, such as a required undergraduate course, would ensure commensurate levels of skill and knowledge amongst graduating teachers, and would better prepare them for the diverse needs of the students they will serve.
Increasing access to experts would help with training and professional development. Training teachers and clinical professionals to develop and maintain their own professional learning networks (PLN), and how to find the information they need, may be one option. Education students who take the course EDIT 202 at the University of Alberta (U of A) learn these skills; similar training could be incorporated into professional development plans of speech pathologists and health professionals.
Accessibility of continuing training opportunities is an issue, as opportunities are often centralized and difficult to get to (especially for rural professionals). The author lists a number of options for training delivery. A mobile training program might also be a cost-effective option that would allow hands-on training opportunities for certain AT devices, which could supplement online training or via tele-training. As a model, I will include in my reference list, below, some articles describing the DOVE study my group undertook to assess the effectiveness of a mobile training program to enhance physician skill and knowledge and subsequent diabetes patients outcomes.(Johnson et al., 2005; Maddigan et al., 2004; Majumdar et al., 2003; Majumdar et al., 2001)
Amongst the three respondent groups, there was consensus that funding was the primary barrier. Lack of funding impacts AT availability, which was another important concern for all respondent groups. The author states:
“The provision of AT tools facilitates participation in education and fosters independence for the child with disabilities in the classroom, home, and community environments and could be seen to be as essential as glasses and hearing aids. There should be a reliable source of a minimal level of funds available for students with disabilities available at the provincial level. Although this would not eliminate the expense and funding barrier, as some equipment is very costly and low cost options may not be sufficient, it would provide a start to equipping students.” (Chmiliar, 2007:15)
I agree that a centralized source for funding has the potential to facilitate improved, consistent and more equitable access to AT. A government funding program may be more cost-effective on a ‘grande scale’; for instance, in terms of volume discounts some manufacturers/suppliers offer. As well, the administration of the program could be streamlined to reduce the duplication of administrative processes and tasks. Equity might be enhanced as individuals would not be limited by the level of resources available via their local community organizations or school boards (if available at all). This could mediate the factor of rural vs. urban residence.
Centralization could include an equipment sharing and loaning program and an equipment trial program, which the author also suggests as an option to help address the barrier of equipment availability. (Chmiliar, 2007)
Centralization may also facilitate better communication between end-users (practitioners, students/patients) and vendors/manufacturers with respect to user needs. (Chmiliar, 2007) This may help address the clinical practitioners’ self-perceptions of being unskilled or needing support, which may stem from their experiences of not having adequate tools to support their clients’ needs.
Question # 3. Would data from the jurisdiction in which you live or work be similar to or different than the data presented for Alberta?
I live in Alberta, the jurisdiction comprising the article’s study area. So, to answer this question, I will instead share some of the available resources and current initiatives, as well as some policy trends that have occurred in the education sector (with respect to individuals who have special needs) since the article was published in 2007.
At the University of Alberta, Education students are required to take at least one course on education/instructional technology. Many take the EDIT 202 course, which I just completed. Much of this course encompassed the incorporation of digital learning tools that had the potential to serve as assistive technology (AT) and mediate disabilities, with an overall philosophy of Universal Design Learning (UDL). We also were required to start a professional learning network (PLN).
Alberta Education’s Inspiring Education (2010) policy document includes as a guiding principle Inclusive, Equitable Access:
“Every learner should have fair and reasonable access to educational opportunities regardless of ability, economic circumstance, location, or cultural background. Their needs and ways of life should be respected and valued within an inclusive learning environment. Some learners will require additional, specialized supports to fully access these opportunities.” (Alberta Education, 2010:32)
See: http://www.inspiringeducation.alberta.ca/LinkClick.aspx?fileticket=BjGiTVRiuD8%3d&tabid=124
Diverse Learning Needs / Supporting Every Student policies and initiatives are incorporated under Alberta Education’s Inclusive Learning Supports Branch (web site: http://education.alberta.ca/admin/supportingstudent/diverselearning.aspx)
Alberta Education’s Assistive Technologies for Learning online resource provides frameworks for AT assessment, decision-making and best practices, and sample AT toolkits. See: http://education.alberta.ca/admin/technology/atl/bestpractices.aspx
Alberta Education’s initiative supporting differentiated learning includes an online resource for teachers. See: http://education.alberta.ca/teachers/resources/cross/making-a-difference.aspx
There is a chapter dedicated to how to incorporate differentiated learning for teaching students who have disabilities. See: http://education.alberta.ca/media/1234001/11_ch8%20students.pdf
Any student in Alberta who is assessed as having special needs (including gifted and talented students) is entitled to have an individual education plan (IEP) created for them. See: http://education.alberta.ca/admin/supportingstudent/diverselearning/ipp.aspx
Alberta Education’s Innovative Classrooms initiative (2008-2011) provided school districts with a funding allocation that supported the purchase an instructional computer, projector and interactive whiteboard for every classroom. Districts could then use any remaining funds towards other technology supports, including AT. See: http://education.alberta.ca/admin/technology/classrooms.aspx
Under the umbrella of Alberta Education, regional learning consortia offer training opportunities, including in-services. See: http://education.alberta.ca/department/about/players/consortia.aspx
The Edmonton Regional Learning Consortium (ERLC) and Alberta Regional Professional Development Consortia (ARPDC) offer some comprehensive online resources for education professionals, as well as training opportunities. See:
http://education.alberta.ca/media/7007858/summerinstituteregisternowposter.pdf
http://www.inclusiveeducationpdresources.ca/
http://www.arpdc.ab.ca/pd/index.html [This is a great site for resources. It includes videos, webinars and facilitated sessions utilizing a Blackboard learning management system (LMS) interface]
In addition to incorporating UDL philosophy, Alberta Education policies and initiatives are informed and guided by the technology in education trends outlined in the annual New Media Consortium (NMC) Horizon Report. Here is a link to the preview of the 2013 K-12 report, which will be released in June: http://www.nmc.org/publications/2013-horizon-report-k12
Here is a link to the 2012 report for K-12: http://www.nmc.org/publications/2012-horizon-report-k12
The 2012 report describes how new trends in technology, such as natural user interfaces (Johnson, Adams & Cummings, 2012:33), can profoundly impact education for students who have special needs.
Here is a resource from Alberta Information Learning Service (ALIS) that provides resources for students and their families regarding planning ahead and transitioning to post-secondary education: http://alis.alberta.ca/ec/ep/pps/planning/disability.html
Alberta Education provides Program Unit Funding (PUF) for the addition of supportive services to early childhood education programming for children 3 ½ to 6 who have special needs. This includes children who have moderate to severe developmental disabilities, as well as gifted and talented children. See: http://www.education.alberta.ca/parents/ecs.aspx
In addition to these above resources for supporting teachers, many (if not all) school districts in Alberta have resources to support an AT expert. My own school division, which serves a rural area of Alberta, has a full-time position for an Educational and Assistive Technology Coordinator, and part of this position’s role is to facilitate and deliver training for district teachers.
Of course, many of the above are policies and initiatives that incorporate a degree of idealism. I do not yet have first hand experience in Alberta education system, and therefore cannot comment on how effectively these initiatives and policies are being implemented, especially with respect to the AT needs of students who have special needs.
There are, of course, online courses such as PSYC 576, which teachers could take to gain expertise. (Chmiliar & Cheung, 2007)
I think the most important thing to note is the potential for the Internet to facilitate convenient, on-demand professional development for education professionals, and access to a network of other education professionals, regardless of practice location. All Alberta schools (though perhaps not First Nations reserve schools) have internet connectivity via Alberta SuperNet. The Alberta initiative for School Improvement (AISI) network has launched an online open learning community for educational professionals. See: http://education.alberta.ca/teachers/aisi.aspx
However, the easy availability of online resources does not necessarily mediate the barrier of teacher time for training and professional development. It can be extremely time consuming to locate and review resources, and then incorporate the concepts into lesson planning, etc. In-person exposure and interaction are not facilitated by online resources, which may also limit the learning experience.
A recent study by McGhie-Richmond et al (2013) surveyed a single rural school district serving central Alberta regarding teachers’ perspectives on inclusive education. Responses regarding training and support were consistent with those from Chmiliar’s (2007) study regarding AT. These findings were also consistent with an earlier study carried out by Salend (2005) regarding teachers’ perspectives on inclusive education in urban settings. However, via a qualitative component to their study, McGhie-Richmond et al (2013) found that many teachers felt they did not need specialized training in inclusive education.
I’m not as familiar with the speech pathologist profession, nor health professionals who serve individuals who have special needs. And I had some difficulty finding information regarding policies and programs that might support these professionals in their practices.
There is a centre of expertise at the Glenrose Hospital, (Alberta Health Services) called the I CAN Centre for Assistive Technology. This centre assists individuals by providing needs assessments, matching them with AT options and providing training, and also assisting them with applying for funding from the Alberta Aids to Daily Living (AADL) program or private medical insurance. See:
http://www.albertahealthservices.ca/services.asp?pid=service&rid=5789
There’s the Assistive Technology Lab at the U of A (Dept of Rehabilitation Medicine Research), which is doing some really interesting work with robotics. See:
http://www.uofaweb.ualberta.ca/rehabmedresearch/atlab.cfm
There’s also the The Edmonton Oilers Community Foundation Children’s Speech Research Laboratory at the U of A, which has a number of publications listed (none of which appear to be open source journals, however). Graduate students comprise part of this lab, as do collaborators from a number of allied departments at the U of A and international institutions. The lab also receives funding from the Stollery Children’s Hospital Foundation Research Grant, NSERC, and Alberta Heritage Foundation for Medical Research (an equipment grant). See:
http://www.uofaweb.ualberta.ca/rehabmedresearch/nav03.cfm?nav03=71659&nav02=71657&nav01=66337
Although children, families and practitioners may receive support from engagement with these centres and labs, they are not generally accessible resources for those not directly involved in care and research at these locations. For instance, the I CAN centre serves clients north of Red Deer; clients must be referred by a health professional; and children must first access services and resources through their schools.
To maintain registration with the Alberta College of Speech-Language Pathologists and Audiologists (ACSLPA), practitioners must engage in a Continuing Competency Program (like a professional development plan) whereby they set training goals and must provide evidence of how they have met these goals. ACSLPA offers some funding sponsorship to members to help them undertake continuing education activities, including those listed here: http://www.acslpa.ab.ca/admin/contentx/default.cfm?p=1&h=9993&PageId=9993. There’s also an annual ACSLPA professional conference.
I knew that the University of Alberta (U of A) no longer offers a Bachelor’s level degree in speech pathology, so I wanted to find out more information regarding the AT exposure and training speech pathologists currently receive. Survey responses from this group indicated the majority received training and exposure at the undergraduate level. The last U of A BSc-SLP class convocated in 1993, and the current entrance requirements to the Master’s SLP program do not specifically require an undergraduate prerequisite relating to AT. Perhaps most survey respondents graduated in or before 1993. Currently, registration with the ACSLPA requires completion of a Master’s degree (individuals with Bachelor’s degree were grandfathered in when this professional entry requirement was initiated July 1, 2002) (personal communication, May 30, 2013) Currently, students gain AT exposure and training via a required clinical practicum. Since 1995, SLP Master’s students have been required to complete a course during the first year of their degree: SPA 523: Augmentative/Alternative Communications Systems. This course provides an overview of AT as well as assessment in intervention processes (personal communication, May 30, 2013). I’ve been unable to find whether a course specifically relating to AT was a requirements of the BSc SLP, or whether it was an option, in-service, satellite workshop, etc. Since the course Augmented/Alternative Communications Systems was not offered prior to 1995 (personal communications), it may be that there was no specific requirement as part of the BSc SLP. So, this may represent a change impacting speech pathologists (i.e. more newer grads) since the survey (even though the change occurred several years before the survey). If the survey were redone today, it may yield slightly a slightly different set of responses with respect to the source of pre-service training.
References:
Alberta Health. (2010). Insipring Education: A Dialogue With Albertans. Alberta Education: Edmonton. Retreived from: http://www.inspiringeducation.alberta.ca/LinkClick.aspx?fileticket=BjGiTVRiuD8%3d&tabid=124
Chmiliar L. Perspectives on assistive technology: What teachers, health professionals, and speech and language pathologists have to say. Developmental Disabilities Bulletin 2007;35(1 & 2):1-17.
Chmiliar L, Cheung B. Assistive technology training for teachers – Innovation and accessibility online. Developmental Disabilities Bulletin 2007;35(1 & 2):18-20, 22-28.
Johnson JA, Eurich DT, Toth EL, Lewanczuk RZ, Lee TK, Majumdar SR. Generalizability and persistence of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes. Diabetes Care 2005;28:783-788.
Johnson L, Adams S, and Cummins M. (2012). NMC Horizon Report: 2012 K-12 Edition. Austin, Texas: The New Media Consortium. Retreived from: http://www.nmc.org/pdf/2012-horizon-report-K12.pdf
Maddigan SL, Majumdar SR, Guirguis LM, Lewanczuk RZ, Lee TK, Toth EL, Johnson JA. Improvements in Patient-Reported Outcomes with an Intervention to Enhance Quality of Care for Rural Patients with Type 2 Diabetes: Results of a Controlled Trial. Diabetes Care 2004;27:1306-1312.
Majumdar SR, Johnson JA, Guirguis LM, Lewanczuk RZ, Lee TK, Toth EL. Rationale and Design for the DOVE Study: A Prospective Controlled Trial of an Intervention to Improve Care for Patients with Diabetes in Rural Communities. Canadian Journal of Diabetes Care 2001;25(3):173-179.
Majumdar SR, Guirguis LM, Toth EL, Lewanczuk RZ, Lee TK, Johnson JA. Controlled trial of a multifaceted intervention for improving quality of care for rural patients with type 2 diabetes. Diabetes Care 2003;26:3061-3066.
McGhie-Richmond D, Irvine A, Loreman T, Cizman JL, Lupart J. Teacher Perspectives on Inclusive Education in Rural Alberta, Canada. Canadian Journal of Education 2013;36(1):195-239. Retreived from: http://www.google.ca/url?sa=t&rct=j&q=rural%20alberta%20assistive%20technology&source=web&cd=9&ved=0CFYQFjAI&url=http%3A%2F%2Fojs.vre.upei.ca%2Findex.php%2Fcje-rce%2Farticle%2Fdownload%2F1155%2F1469&ei=NKmnUYu_I4WEiwLB2YD4DQ&usg=AFQjCNFatM2KSdrbzYwiJTxqG1T6lGAKRA
Salend SJ. (2005). Creating inclusive classrooms: Effective and reflective practices (5th ed.). New Jersey, Merrill.
Technology for Teaching & Learning 