AT personnel, the Reflective Practitioner and Ethics

Assistive Technology Service(from Assistive Technology Act of 1998-PL 105-394)

"Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.“

This may include:evaluation of the needs of an individual with a disability, including a functional evaluation of the individual in his/her customary environment (evaluating their needs in their usual surroundings) purchasing, leasing, or otherwise providing for the acquisition of assistive technology devices by individuals with disabilities purchasing, selecting, or borrowing AT devices selecting, designing, fitting, customizing, adapting, applying, maintaining, repairing, or replacing of assistive technology devices

Assistive Technology Service cont

coordinating and using other therapies, interventions, or services with assistive technology devices, such as those associated with existing education and rehabilitation plans and programs

providing training or technical assistance for an individual with a disability, or where appropriate, the family of an individual with a disability

providing training or technical assistance for professionals (including individuals providing education and rehabilitation services), employers, or other individuals who provide services to, employ, or are otherwise substantially involved in the major life functions of individuals with disabilities.

Assistive Technology Device(from Assistive Technology Act of 1998-PL 105-394)

"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 individuals with disabilities."

Definition of AT

The International ISO-9999 standard defines AT as:

“Any product, instrument, equipment or technical system used by a disabled or elderly person, made specially or existing on the market, aimed to prevent, compensate, relive or neutralize the deficiency, the inability of the handicap.” 2007

"Any product (including devices, equipment, instruments and software), especially produced or generally available, used by or for persons with disability

for participation; to protect, support, train, measure or substitute for body functions

/ structures and activities; or to prevent impairments, activity limitations or participation

restrictions." 2011

http://cirrie.buffalo.edu/encyclopedia/en/article/265/

http://www.abledata.com/abledata.cfm?pageid=194670&ksectionid=19327

ISO 9999 defines 12 functional areas called "classes," each of which is subdivided into "subclasses." Within most subclasses, more specific

categories called "divisions" are listed

04 ASSISTIVE PRODUCTS FOR PERSONAL MEDICAL TREATMENT Included are those assistive products which are

intended to improve, monitor or maintain the medical condition of a person. Excluded are assistive products used exclusively by health-care professionals.

05 ASSISTIVE PRODUCTS FOR TRAINING IN SKILLS Included are, e.g., devices intended to

improve a person's physical, mental and social abilities. Devices that have a function other than training, but which may also be used for training, should be included in the class covering its principal function.

ISO 9999

06 ORTHOSES AND PROSTHESES Orthoses are externally applied devices used to modify the structural and

functional characteristics of the neuromuscular and skeletal systems.Prostheses are externally applied devices used to replace, wholly or in part, an absent or deficient body part.Included are, e.g., body powered and externally powered external orthoses, prostheses, cosmetic prostheses, and orthopedic footwear.Excluded are endoprostheses, which are not part of this International Standard.

09 ASSISTIVE PRODUCTS FOR PERSONAL CARE AND PROTECTION Included are, e.g., assistive products for dressing and undressing; for

body protection; for personal hygiene; for tracheostomy, ostomy and incontinence care; and for sexual activities.

Assistive products for eating and drinking, 12 ASSISTIVE PRODUCTS FOR PERSONAL MOBILITY

ORTHOSES AND PROSTHESES, Assistive products for carrying and transporting, Assistive products for transporting objects in the workplace,.

ISO 999915 ASSISTIVE PRODUCTS FOR HOUSEKEEPING

Included are, e.g., assistive products for eating and drinking.18 FURNISHINGS AND ADAPTATIONS TO HOMES AND OTHER PREMISES

Sets of castors, Assistive products for environmental improvement, Workplace furniture and furnishing elements,

22 ASSISTIVE PRODUCTS FOR COMMUNICATION AND INFORMATION Devices for helping a person to receive, send, produce and process

information in different forms.Included are, e.g., devices for seeing, hearing, reading, writing, telephoning, signalling, and alarming; and information technology.

Assistive products for office administration, information storage and management at work,

24 ASSISTIVE PRODUCTS FOR HANDLING OBJECTS AND DEVICES Assistive products for transporting objects in the workplace Assistive products for hoisting and repositioning objects in the

workplace,

ISO 9999

27 ASSISTIVE PRODUCTS FOR ENVIRONMENTAL IMPROVEMENT AND ASSESSMENT

Devices and equipment to enhance and measure the environment. ASSISTIVE PRODUCTS FOR EMPLOYMENT AND VOCATIONAL TRAINING,

28 ASSISTIVE PRODUCTS FOR EMPLOYMENT AND VOCATIONAL TRAINING

Devices which exclusively fulfill the requirements of the workplace and for vocational training.Included are, e.g., machines, devices, vehicles, tools, computer hardware and software, production and office equipment, furniture and facilities, and materials for vocational assessment and vocational training.Excluded are products that are mainly used outside of the work environment.

ASSISTIVE PRODUCTS FOR TRAINING IN SKILLS, ASSISTIVE PRODUCTS FOR PERSONAL MOBILITY, FURNISHINGS AND ADAPTATIONS TO HOMES AND OTHER PREMISES, ASSISTIVE PRODUCTS FOR COMMUNICATION AND INFORMATION,

30 ASSISTIVE PRODUCTS FOR RECREATION Devices intended for games, hobbies, sports and other leisure activities.

Definition of AT

The European TIDE/HEART study (1994) looked at AT from the perspective of its outcomes, bringing in the human dimension and concluded that:

“The ultimate objective of AT is to contribute to the effective enhancement of the lives of people with disabilities and elderly people helping to overcome and solve their functional problems, reducing dependence on others and contributing to the integration into their families and society.”

AT Service Ireland?

Nine recommendations were made by the Commission of the Status of People with Disabilities (1996) on technology and telecommunications for people with disabilities,

In particular three recommendations referred to the provision of AT services.

http://www.nda.ie/cntmgmtnew.nsf/0/9007E317368ADA638025718D00372224/$File/strategy_for_equality_04.htm

Strategy for Equality 96

The Department of Social Welfare and the Department of Transport, Energy and Communications should introduce legislation to ensure access to assistive technology and telecommunications in line with the UN standard rules. Access to this technology should include financial access.

- Recommendation 271

Strategy for Equality 96

A single existing agency should be responsible for all assistive technology and for dissemination of information about new technological developments. Services should continue to be provided by a mixture of state and voluntary organisation but voluntary sector services must be properly funded and regulated. This agency should also provide an adequate assessment service of the most appropriate technical aids for people with disabilities.

- Recommendation 272

Strategy for Equality 96

One agency should be responsible for all technology and for giving out information about new kinds of equipment. This overall agency should set up nominated assessment centres and support them with appropriate funding for equipment, staff and training. There should also be a county network of ‘feeder’ or ‘outreach’ centres to provide primary assessments and training. All assessment must be based on a person centred approach.

- Recommendation 273

Implementation?

None of the recommendations have been fully implemented to date

it was reported that “Neither the Department of Public Enterprise nor the Department of Social Community and Family Affairs see the recommendations as falling with their brief

This leaves the provision of AT in the remit of Department of Health and Children through which it is largely considered ”aids and appliances”.

Current State of Practice

Still many of the EU countries have adopted, in principle, or in practice, the “Medical Model” where advice and decision making is largely dependent on the professionals in the field (medical doctors and therapists / advisors).

These professionals play a crucial role in bringing together the needs and available assistive technology, however in reality, these professionals all too often have insufficient knowledge as to the latest technology advances and available solutions

Analysing & Federating

National Physical and Sensory Disability Database

This is well illustrated in the report of the National Physical and Sensory Disability Database Development Committee (Gallagher 2001).

report contains no reference to the provision of AT services.

The intention of the database is to gather information on technical aids and appliances currently being used by people with disabilities. The areas covered are aids to mobility, orthotics and prosthetics, vision aids, aids to hearing, communication aids, incontinence aids, special furniture and other aids to personal care.

For each technical aid and appliance identified, there are three subsequent fields to identify up to three individuals who assessed/authorised that particular aid and appliance,

http://www.hrb.ie/health-information-in-house-research/disability/npsdd/

National Physical and Sensory Disability Database

The list of professionals involved includes, audiologists, audiometricians, community resource workers, continence advisors, G.Ps, information technology specialists, nurses, occupational therapists, ophthalmologists, optometrists, orthotists, physiotherapists, prosthetists, mobility specialists, seating technicians, speech therapists and suppliers.

It would appear from this listing that AT is still considered a rehabilitative tool viewed solely as helping in the eventual rehabilitation of the “patient” rather than as an enabling tool to support people with disabilities to achieve a better quality of life.

Education for People with Disabilities Act 2004

The Education for People with Disabilities Act, eligibility both for support and technology service hinges on the assessment of the individual, an assessment carried out by two or more of the following

An educational psychologist A medical practitioner A teacher nominated by the principal of the

school where the child is attending A social worker A therapist

Education for People with Disabilities Act 2004

It is evident from the medical background of the personnel involved that the emphasis is on the diagnostic factors of the person’s special needs.

A broader view of the person needs to be to be considered and in particular the person’s “abilities” and how “enabling” technology can have a positive impact on both the behaviours and quality of life of the person

EU Research 2009

The AT ICT value chain in Europe

EU Telemate Project

The assistive technology (AT) provision cycle involves, by its nature, a heterogeneous group of disciplines.

Skills are needed in design, manufacture, user assessment, delivery, maintenance, disposal; and, use

http://www.fernunihagen.de/FTB/telemate/database/isced.htm

Earlier Research

The TIDE “HEART” project (report

E.3.2) identified three areas of education and training in Assistive Technology for specialists

HumanSocio-economic, and Technical.

HEART area – Human

Basic profession Clinical

with underpinning disciplines Anatomy Physiology Biomechanics Disabilities Psychology Sociology Knowledge transfer, and Ethics

HEART area – Socio-economic

Basic profession Administration

with underpinning disciplines Management Service delivery Standards, testing Legislation Economics

HEART area – Technical

Basic profession Engineering

with underpinning disciplines Mechanics Electronics Physics Information Technology etc.,

Human

Engineering

Socio-Economic

Specialist medical & welfare education

Knowledge for medical administration

Knowledge for medical

engineering

Specialist administrative education

Knowledge for AT engineering administration

Specialist engineering

education

Core knowledge

for all professionals

Knowledge of Assistive Technology

ATUser

Knowledge for non-professional users

International Standard Classification of Education (ISCED); UNESCO

ISCO skill Level

First skill level

Second skill level

ISCED Categories ISCED category 1, comprising primary

education which generally begins at ages 5-7 years and lasts about 5 years.

ISCED categories 2 and 3, comprising the first and second stages of secondary education. The first stage begins at the age of 11 or 12 and lasts about three years, while the second stage begins at the age of 14 of 15 and also lasts about three years. A period of on-the-job training or experience may be necessary, sometimes formalised in apprenticeships. This period may supplement the formal training or may replace it partly or, in some cases, wholly.

International Standard Classification of Education (ISCED); UNESCO

Third Skill Level

Fourth Skill Level

ISCED category 5 (category 4 has been deliberately left without content) comprising education which begins at the age of 17 or 18, last about four year, and leads to an award not equivalent to a first university degree.

SCED categories 6 and 7, comprising education which begins at the age of 17 or 18, lasts about three, four or more years, and lead to a university or postgraduate university degree or the equivalent.

“ISCED” is UNESCO’s International

Standard Classification of Education

AT accreditation USA - Resna

The rising expectations of end-users are forcing accreditation away from qualifications based on knowledge to demonstrate competence in practice

Competence applied to whole services in which a skill mix can be provided in a number of ways depending on the needs of the user

RESNA Rehabilitation & Engineering Society of North America

In the US RESNA have developed a package of qualifications for AT professionals

Assistive Technology Practitioner Assistive Technology Supplier Rehabilitation Engineering

Technologist

Evert-Jan Hoogerwerf

Aspects of

Assistive Technology Education in a European context

Keeping Pace with Assistive Technology, Guidelines for Lifelong Learning in Assistive Technology

http://www.at4inclusion.org/kpt/kpt_project.php

Professionals involved in AT

0 5 10 15 20 25 30 35

Rehab Engineer

Social worker

AT advisor

Clinical Scientist / medical engineer

Architect

AT supplier

Psychologist

Doctor

Personal assistant

Other

OT

PT

SLT

Teacher / Educationalist

•Majority (79%) of professionals reported working in two or more settings and in two or more teams

135 responses

Only 20% of 135 professionals interviewed

Nb The mean number of years post qualification was 12.1 years

Post-qualification AT training

38% didn’t receive training

62% did receive training

AT as part of formal pre-qualification education

Training Needs Analysis

Professions studying aspects of AT as part of formal pre-qualification education

Frequency

Physiotherapist 1

Doctor 2Teacher, Educationalist

4

OT 7

SLT 13

Total 27

Nb The mean number of years post qualification was 12.1 years (N= 125, range 1-35, SD=8.65)

Factors that influence Assistive Technology decision making

Elizabeth A Lahm; Leslie Sizemore

Journal of Special Education Technology; Winter 2002; 17, 1; ProQuest Nursing & Allied Health Sourcepg. 15

Factors that influence Assistive Technology decision making

Factors that influence Assistive Technology decision making

Factors that influence Assistive Technology decision making

Factors that influence Assistive Technology decision making

AT training programmes at universities and colleges were highly multidisciplinary.

Almost three-quarters (18 of 25) were sponsored by more than one department within the university or college.

Assistive technology training: Diverse audiences and multidisciplinarycontent, Lita Jans & Marcia Scherer in Disability and Rehabilitation: Assistive Technology, January-June 2006; 1(1-2): 69 – 77

Areas of AT

Biomedical Engineering, . Child Development, . Communication, . Disability and Human Development, . Education, . Engineering, . Health and Human Development, . Health and Rehabilitation Sciences, . Gerontology,

Areas of AT

Industrial Design, . Occupational Therapy, . Psychology, . Physical Therapy, . Rehabilitation Engineering, . Rehabilitation Medicine, . Rehabilitation Science and Technology, . Speech and Hearing Sciences, and . Vocational Rehabilitation.

AT Professionals

Professionals in the counseling field have an ethical responsibility to be aware of the technology available,

Must be comfortable with deploying AT. Studies have shown like consumers of AT

services, providers of AT services likely demonstrate a wide range of emotions from being ‘‘techno-centered’’ to extraordinarily ‘‘techno-anxious.’’

Reflective Practitioners

But first…on 2 slips of paper…

On one slip of paper…legibly write down your definition of “reflection” in 60 seconds.

On the second slip of paper…BRIEFLY jot down thoughts about how our culture & society views and practices “reflection” in 60 seconds.

Then second…

Share your ideas with the people beside you for 2 minutes

Now share with the class…

The Reflective Practitioner

Reflective practice is a continuous process and involves the learner considering critical incidents in his or her life's experiences.

It was introduced by Donald Schön in his book The Reflective Practitioner in 1983.

As defined by Schön, reflective practice involves thoughtfully considering one's own experiences in applying knowledge to practice while being coached by professionals in the discipline.

described as an unstructured approach directing understanding and learning, a self regulated process, commonly used in Health and Teaching professions, though applicable to all.

The Reflective Practitioner

Donald Schon

Philosopher, researcher, professor emeritus (MIT), made significant contributions to the theory and practice of learning. Concerned with professional learning, learning processes in organizations, and with developing critical, self-reflecting practice

The Reflective Practitioner: How Professionals think in Action (1983)

Educating the Reflective Practitioner (1987)

Reflection

Latin “reflectere” : To bend back

Involves “shuttling back and forth between thinking and action”

Definition

Reflection has been defined as “a generic term for those intellectual and affective activities in which individuals engage to explore their experiences in order to lead to a new understanding and appreciation.”

Definition

“Reflection is a basic mental process

with either a purpose, an outcome,

or both, applied in situations in

which material is unstructured or

uncertain and where there is no

obvious solution.”

Why reflect

Manage emotions – ordering / controlling emotions – Mindlfulness work to manage anxiety &

Re-processing to discharging emotions – Pennebaker’s expressive writing

Embracing change & avoiding burnout – reducing fear of change, looking for patterns

‘Writing about earlier traumatic experience was associated with both short-term increases in physiological arousal and long-term decreases in health problems’ Pennebaker & Beall, 1986: 

Pennebaker, J. W. & Beall, S. K. (1986) Confronting a traumatic event. Toward an understanding of inhibition and disease. Journal of Abnormal Psychology, 95, 274–281

Why Reflect

Manage behaviour – maintain motivation

Demonstrate ethical practice / accountability

See thoughts feelings behaviour links

Potential benefits of reflection

Improved practiceDevelopment of self regulationFacilitation and integration of

theory and practiceDevelopment of personal

theories of practice

Retrospective or ‘Real Time’

Reflection after the event

After the event becoming self aware

Action orientated Should lead to

change

Reflection during the event

Self monitoring Concurrent

awareness Knowing and doing

implicit checklist

Reflection framework

Reflection in Action

The sorts of knowledge we reveal in our intelligent action – publicly observable, physical performances like riding a bicycle and private operations like instant analysis of a balance sheet. In both cases, the knowing is in the action. We reveal it by our spontaneous, skillful execution of the performance…” Schon, 1987

Thinking on your feet

Knowing in action: knowing more than we can say, the capacity to do the right thing (tacit knowledge).

Reflection in Action

Pausing after an activity to see how it went – what went well, what did not, what could be changed;

We develop sets of questions and ideas about our activities and practice

Looking back on experience to improve practice

Learning in the midst of practice Making decisions about what to do

Donald Schon

Reflection Frameworks - basic

1. Description – What happened2. Evaluation – what went well,

what didn’t3. Analysis – what thoughts, feelings,

behaviours, contributed

to success- 4. Action – What next

Reflection homework

Attending to emotional responses – working more skilfully with emotions

Managing unhelpful feelings Working with surprises – positive &

negative Notice tendency to avoid recalling

experience

Reflection homework

Identify attitudes, beliefs, feelings - that helped, - that got away

Consequences for self concept - professional identity supported or challenged-Personal identity supported or challenged

Critical reflection – challenge the validity of our presuppositions

EI:Key components

Personal competence» self awareness » self management (self confidence, integrity, initiative, value base

Social competence »Social awareness

»Relationship management (empathy, supporting others, managing conflict, team working & group dynamics

Goleman’s 5 point Framework

Self awareness – understanding own motivation, strengths & weakness, how one is perceived by others

Empathy – ability to see others’ perspective and use it in a helpful way

Self regulation – ability to control one’s self and think before acting

Social skills – communicating and relating to others

Epstein, R. M., & Hundert, M. (2002). Defining and assessing professionalcompetence. JAMA 287, 226–235.

»

Reflective Cycle - from Gibbs (1988)

Description-What happened?

Feelings-What were you thinking and feeling? What lead you to that decision or opinion ?

Evaluation-What was good and bad about the experience?Analysis-What sense can you

make of the situation? What have you learnt? What does the literature say ?

Conclusion-What else could you have done?

What have you learnt?

Action Plan-If it arose again what would you do? Would you do things differently ?

ReflectionReflection is the bridge is the bridge betweenbetween thinkingthinking and and actingacting

EXERCISE 1

As a group spend 15 minutes answering the following two questions;

What have you learned in this MSc in AT so far?

What have you achieved on this MSc in AT so far?

How do you define a Profession?

Profession

"A profession is a disciplined group of individuals who adhere to ethical standards and who hold themselves out as,

are accepted by the public as possessing special knowledge and skills in a widely recognised body of learning derived from research, education and training at a high level

who apply this knowledge and exercise these skills in the interest of others.

It is inherent in the definition of a profession that a code of ethics governs the activities of each profession.

Practice

Such codes require behaviour and practice beyond the personal moral obligations of an individual.

They define and demand high standards of behaviour in respect to the services provided to the public and in dealing with professional colleagues.

Further, these codes are enforced by the profession and are acknowledged and accepted by the community."

 

Code of Ethics

has two aspects: 

The content comprising the requirements, the rules, principles, ideals etc

The commitment of the members of the occupation or organisation to conform to, and otherwise uphold, these rules and ideals

http://www.professions.com.au/Homepage.html

Codes of Ethics

Code Principles The most obvious way to recognise professional

competencies is by a formal qualification together with peer recognition or references and membership of a professional organisation.

A professional organisation’s standards for entry should also include a requirement to adhere to an enforceable Code of Ethics, the requirement to commit to measurable ongoing professional development and sanctions for conduct that falls below the required standards.

RESNA STANDARDS OF PRACTICE for Assistive Technology Professionals www.resna.org

Standards of Practice set forth fundamental conceptsand rules considered essential to promote the highest ethical standards among individuals who evaluate, assess the need for, recommend, or provide assistive technology.

Hold paramount the welfare of persons served professionally.

Practice only in their area(s) of competence and maintain high standards.

Maintain the confidentiality of privileged information.

Engage in no conduct that constitutes a conflict of interest or that adversely reflects on the association and, more broadly, on professional practice.

Seek deserved and reasonable remuneration for services.

RESNA STANDARDS OF PRACTICE for Assistive Technology Professionals www.resna.org

RESNA Standards cont

Inform and educate the public on rehabilitation/assistive technology and its applications.

Issue public statements in an objective and truthful manner.

Comply with the laws and policies that guide professional practice.

Ethics

• ethics as 'a way of living one’s life in pursuit of excellence.

• Ethics is not just a private matter.  It has its public and private sides—but it cannot be just personal.' 

• Ethics is not mere conformity to rules.' Acting in a way which breaches the law of the land can certainly not be taken to be done in the name of ethics.

Professionals have an ethical obligation to act in the best interest of their client/patient. Ethical duties also prohibit professionals from acting to promote their own self interest. 

Five Core Concepts in Ethics

Nonmaleficence…not causing harm to others

Beneficence…..doing good for others

Autonomy….freedom of action & choice

Fidelity ..faithful, honest behaviour Justice…fairness

Ethical Guidance for Research with People with Disabilities

Ethical GEthical Guidance for Research with People with Disabilities uidance for Research with People with Disabilities

Core Values for Research with People with Disabilities

Promote the wellbeing of those participating, involved in or affected by the research process

Respect the: dignity,

autonomy,

equality

diversity

of all those involved in the research process

Guidance for Good Practice in Research with People with Disabilities

Guidance is provided on six key principles:

•Promoting the inclusion and participation of people with disabilities in research and research dissemination

•Ensuring that research is accessible to people with disabilities

•Avoiding harm to research participants

•Ensuring voluntary and informed consent before participation in research

•Understanding and fulfilling relevant legal responsibilities

•Maintaining the highest professional research standards and competencies