Accessing and Funding Assistive Technology for Young Children with Disabilities

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<ul><li><p>Early Childhood Education Journal, Vol. 28, No. 2, 2000</p><p>Early Childhood Special Education</p><p>Accessing and Funding Assistive Technology forYoung Children with Disabilities</p><p>Sharon Lesar Judge</p><p>INTRODUCTION ACCESSING ASSISTIVE TECHNOLOGYIn the last decade, new assistive technology devices When young children are being considered for as-</p><p>have enabled young children with disabilities to play, sistive technology, the first questions asked are, Whatlearn, communicate, and interact with their environment does it mean to need assistive technology? What ser-to a greater degree than ever before. Even with the thou- vices are available to provide training, technical assis-sands of commercially manufactured and homemade as- tance, and supports to teachers and families? Who willsistive technology devices currently available, profes- pay for the assistive device? As early childhood educa-sionals and parents continue to demand more access to tion professionals and parents thoughtfully look at atechnology. Although the benefits of assistive technol- childs need for assistive technology, some basic infor-ogy for young children seem clear, the reality of funding mation is needed for the development and provision ofshortages, bureaucratic barriers, and accessibility can be assistive technology services that align to federal, state,frustrating and discouraging for families and profession- and local mandates.als alike. Early childhood education professionals are The impetus for the use of assistive technologynow responsible for helping young children and families evolves from the passage of the Technology-Related As-select and acquire assistive technology devices as well sistance for Individuals with Disabilities Act of 1988as instruct them in their use. Unfortunately, many pro- (PL 100-407; commonly referred to as the Tech Act),fessionals have inadequate training and/or experience which expands the availability of assistive technologywith technology, its application, family participation in services and devices for persons of all ages with disabili-the selection and use of assistive technology, and knowl- ties. According to the Tech Act, assistive technology de-edge about accessing funding sources for assistive tech- vices include any item, piece of equipment, or productnology. system, whether acquired commercially, off the shelf,</p><p>As the number of young children using assistive modified, or customized, that is used to increase, main-technology increases, four areas emerge as particularly tain, or improve the functional capabilities of childrenimportant: accessing assistive technology, matching with disabilities. Assistive technologies range from sim-needs of child to technology, funding for assistive de- ple devices, such as adapted spoons and switch-adaptedvices and services, and training for early childhood edu- battery-operated toys, to complex devices, such as aug-cation professionals and family members. Frequently mentative communication aids, powered mobility equip-asked questions, common concerns, and suggestions for ment, and computers and peripheral devices. Using thisearly childhood education professionals and families are definition, assistive technology embraces all devices andreviewed for each of these areas. Finally, the implica- equipment that can help young children with disabilitiestions of that knowledge to improve the availability of to develop and use their skills to the best of their poten-assistive technology to young children and their families tial.are described. The 1997 revision of the Individuals with Disabili-</p><p>ties Education Act (IDEA) further identified assistivetechnology as a special factor that must be considered1The University of Tennessee, Knoxville, Tennessee. by each individualized education plan (IEP) team. The2Correspondence should be directed to Sharon Lesar Judge, The Uni-most significant aspect of the new version is the require-versity of Tennessee, 331 Claxton Addition, Knoxville, Tennessee</p><p>37996-3400; e-mail: ment that need for assistive technology must be consid-</p><p>1251082-3301/00/1200-0125$18.00/0 2000 Human Sciences Press, Inc.</p></li><li><p>Judge126</p><p>ered when developing each childs IEP. IEP teams that type of device (Scherer, 1996). This crisis of technologyabandonment happens for various reasons, ranging fromhave not traditionally considered needs for assistive</p><p>technology, such as the teams for a child with emotional children outgrowing particular assistive devices to pro-fessionals determining what they think is appropriate asdisturbance or with speech and language disabilities,</p><p>must also answer the question: Is there technology that opposed to listening to child and family preferences. Of-ten the reason for this abandonment is that the familyis needed for this child to receive a free and appropriate</p><p>public education or to benefit from the educational pro- has had little say in selecting the assistive device. Othermajor reasons for technology abandonment include (a)gram we have designed?</p><p>Assistive technology services have been defined in lack of meaningful training on how to use the deviceand/or lack of ongoing team support; (b) sophisticationIDEA as a service that directly assists a child with a</p><p>disability in the selection, acquisition, or use of an as- of the device to the extent that it confuses the family,child, and professionals; (c) lack of access to and infor-sistive technology device [34 CFR 303.12(d)(1)]. As-</p><p>sistive technology services to young children include a mation about repair and maintenance; and (d) lack ofmotivation to use the device or do the task for which itnumber of specific supports such as purchasing and leas-</p><p>ing devices and equipment, customizing and adapting is intended (Phillips &amp; Zhao, 1993). To avoid the prob-lem of technology abandonment, early childhood educa-devices, repair of devices, training in the use of devices,</p><p>and coordinating therapies, interventions, and services tion professionals must involve families in all aspects ofassistive technology decision-making.with assistive technology devices (Parette &amp; Murdick,</p><p>1998). Problems associated with abandonment or lack ofimplementation of assistive technology may be a directFederal laws such as the IDEA require that assist-</p><p>ive technology devices and services be provided to chil- outcome of ineffective assessment and intervention pro-cesses. While the field of early intervention has empha-dren with disabilities by the public agency (e.g., public</p><p>school, early intervention program) serving them. With sized family involvement in all aspects of assessmentand intervention, family involvement during assistiveregard to assistive technology, IDEA provides that, if a</p><p>child with a disability requires assistive technology de- technology assessment has been limited (Parette &amp; An-gelo, 1996). For example, agencies providing assistivevices, services, or both in order to receive a free and</p><p>appropriate public education, the public agency must en- technology services may utilize traditional assessmentmethods involving a succession of professionals seeingsure that they are made available to the child, either as</p><p>special education, related services, or as supplementary a child in isolation of the family. Traditional assess-ments, including standardized tests, have been recentlyaids and services. Thus, if assistive technology is identi-</p><p>fied as part of the childs IFSP or IEP, the assistive tech- criticized for not providing relevant information to en-hance the acquisition of functional skills of young chil-nology, as well as the training in the use of it, must be</p><p>provided by the public agency at no cost to the parents. dren with disabilities (Linder, 1993). The results of atraditional assessment may lead to the recommendationof a device geared toward specific school tasks as op-MATCHING NEEDS OF CHILD posed to a tool to facilitate independent functioning of aTO TECHNOLOGYchild in multiple environments. Additionally, therapeuticassistive technology services (e.g., teaching a child toSuccessful use of assistive technology requires</p><p>team-based assessments that lead to identification of ap- use a device) may be conducted in structured settingsthat do not represent natural conditions under which apropriate devices and services. This occurs when family</p><p>members play an active role during the assessment pro- child will be expected to use a device. The lack of fam-ily input in the assistive technology service delivery sys-cess and assistive technology decision making is a col-</p><p>laborative effort between family members and profes- tem may delay a childs progress in generalizing useof a device to natural settings. Finally, the outcomes ofsionals. When family and childs needs, preferences,</p><p>abilities, and experiences are not considered in the as- traditional assistive technology assessments may yieldvery isolated recommendations that may result in limitedsessment process, the selection of the device will most</p><p>likely lead to limited use (Allaire, Gressard, Black- device use by the child and family. One way to increaseappropriate assistive technology recommendations forman, &amp; Hostler, 1991; Culp, Ambrosi, Berniger, &amp;</p><p>Mitchell, 1986) or its abandonment (Parette &amp; Angelo, young children is to develop assessment and interven-tion strategies that promote child and family competen-1996; Scherer, 1996).</p><p>Although many young children gain access to as- cies in the assistive technology decision-making process.Another factor associated with technology aban-sistive technology, studies show rates of technology</p><p>abandonment ranging from 875%, depending on the donment is a failure to identify family needs, resources,</p></li><li><p>127Accessing Assistive Technology</p><p>and support as a component of the assessment process tech assistive deviceson their own. Without financialalternatives to help families obtain these assistive de-(Angelo, Jones, &amp; Kokoska, 1995). IDEA recognizes the</p><p>key role families play in the development of the young vices, young children with disabilities are denied theability to play, learn, communicate, and interact withchild as reflected in language such as family-centered</p><p>or family-focused care. This rethinking of family-cen- family and friends.Early childhood education professionals and fami-tered intervention in assistive technology contrasts</p><p>sharply with a traditional perspective in which the term lies need to become knowledgeable about the most fea-sible sources of funding for assistive technology. Fund-intervention is generally defined either at the level of</p><p>program involvement or in terms of the provision of a ing under IDEA and the Tech Act is available for use insupplying technology-related needs; but with shrinkingspecific professional therapeutic or educational treat-</p><p>ment. For example, many assistive devices that are ac- budgets and limited resources, it is increasingly difficultfor funding sources to process all the requests for assist-quired for young children with disabilities are viewed as</p><p>something used in a school or clinical setting instead of ive devices. As a result, the application process may re-quire substantial energy expenditure and advocacy indevices that increase the independence and functioning</p><p>of children across environments. It is also frequently as- finding a source for funds. Although financial resourcesare often scarce, funding does not limit a childs needsumed that only specialists have the necessary knowl-</p><p>edge and experience to make decisions about appro- for assistive technology. Professionals must assist fami-lies in becoming resourceful and actively involved inpriate devices for children to use. However, the child</p><p>and family have unique expertise concerning their activ- accessing funding mechanisms for needed assistive tech-nology. The following section briefly describes some ofities and goals and the environment in which they live.</p><p>Failure to use this expertise may result in the failure of the major assistive technology funding sources that existat the federal, state, local, and private levels.the device to meet the needs of the child and her family</p><p>and terminate in abandonment of the device.Medicaid</p><p>Medicaid is a jointly funded federal and state medi-FUNDINGcal insurance program for individuals and families withFunding for assistive technologies remains one of low income. The Medicaid program has a durable medi-</p><p>the biggest obstacles to acquiring needed devices andcal equipment category that covers some devices if that</p><p>services. Funding is available from a variety of public device is considered medically necessary and a physi-and private sources. However, finding and paying for</p><p>cians authorization is obtained. Each state develops itsthe right assistive technology can be difficult for fami-</p><p>own regulations for program participation according tolies. This may be due to the high cost of equipmentspecified federal guidelines, and each state may provide(Hofmann, 1988), the restrictive or vague eligibility cri-additional services at their own discretion. Thus, there</p><p>teria imposed by potential public and private sources ofare wide variations in the scope of state services offered.funding (McGuiness, 1982; Ward, 1989), professionals In addition, assistive technology services (e.g., occupa-lack of knowledge about finding funding options (Lesar,tional, physical, and speech therapy) are covered under1998), or locating and accessing third-party payment federal Medicaid law.</p><p>sources (Church &amp; Glennen, 1992). Even with a variety The Early and Periodic Screening, Diagnosis, andof federal, state, and private insurance funding sources, Treatment (EPSDT) program for children from birth tofunding options beyond current practices are very much</p><p>age 21 requires that states cover regular and periodicneeded for young children to obtain assistive technology</p><p>exams for eligible children. This program specifically(Wallace, 1995).states that any medically necessary services or durableAs assistive technology use among young childrenmedical equipment prescribed by EPSDT must be pro-</p><p>with disabilities becomes more widespread and as tech-vided, even if that service is not covered in that states</p><p>nologies continue to become increasingly sophisticated, Medicaid program. This includes assistive devices thatboth their total cost and the demand for them rises. Formay have been excluded under the regular Medicaid</p><p>example, augmentative and alternative communication program.(AAC) devices, such as the Macaw by Zygo, cost up to$2,200. A Dynavox augmentative communication de- CHAMPUSvice, which, through software, provides synthesizedspeech via direct touch, joystick, auditory or visual scan- The Civilian Health and Medical Program of the</p><p>Uniformed Services (CHAMPUS) is a federally-fundedning modes, costs $5,300. Thus, very few families canafford to pay for high-tech devicesor even many low- medical benefits insurance program for spouses and</p></li><li><p>Judge128</p><p>children of active duty, retired, and deceased active duty change (Hutinger, Johanson, &amp; Stonebur...</p></li></ul>


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