3 Segment 1: Factor 1 Modeling the ATA process Segmento 1: Fattore 1 Modellizzare l’ATA processIn this first segment I will include a presentation of a new ideal Assistive Technology Assessment process based on the biopsychosocial model of disability and used in a center for assistive technology provision.
4 Models of AT delivery in Western countries Public Health SystemMost of European Countries (e.g. Italy)Private Health SystemSeveral Anglo-Saxon Countries (e.g. USA)2 ModelsUsers of noncommercial advisory service and support on AT (e.g. Center for Assistive Technology in Italy)Clients of commercial provision of AT (e.g. Center for Assistive Technology in USA)Patients of medical center for technical aid (e.g. Dep. of Physical Medicine & Rehabilitation of University of Rochester)RecipientsFree of chargeIn a Public Health SystemFee-payingIn a Private Health SystemProductPublicHealth SystemPrivatechargeno chargeuserpatientclientModels Recipients Fees Modelling an ideal model of effective Assistive Technology Assessment process of a center for AT provision is difficult if one takes into account the extraordinary variety of systems of regional and national health and social care, both public and private in Western countries.Just to synthesize, in a schematic way, some of these differences, we have divided in 2 models the main national health systems in the Western countries: the Public and the Private health systems. According to each national health system model, the recipient of the health system can be characterized as a user of noncommercial AT service delivery, or a client of commercial provision of AT, or a patient of a medical center for technical aid. Finally, according to each national health system model, the AT will be free of charge in a public health system or by paying in a private health system.[click]This other diagram displays better as the elements of each model are often mixed rather than juxtaposed. For example, the recipient of an AT in medical center for AT could be a patient both in Private and in Public Health Systems.
5 ATA process 55 Scholars from 5 Continents Institute for Matching Person & TechnologyCenter for Technical Aid, Leonarda VaccariATA processThe assistive technology assessment process is not a result of a mere academic mental exercise, but provides examples of applications of it.The theoretical view of the ATA process emerges from experimental research applied to rehabilitation and assistive technologies; the international ideal model of assistive technology assessment process is already applied in centers for technical aid.Thanks to scientific and clinical collaboration, economic and operational support of the center for Technical Aid of Rome, Leonarda Vaccari Institute – which, in turn, is part of the Italian Network of centers Advice on Computer and Electronic Aids and cooperates with the Institute for Matching Person & technology.It was possible to define the assessment model proposed in the present workshop since the model is already operative in the center of Rome.This center offers a non-commercial advisory service and support on assistive technologies and computers for communication, learning, and autonomy. The service is free of charge for users who access it through the Italian National Health Service. Several scientific projects granted by the Institute are in progress at the center to verify not only the advantages of a systematic application of the Matching Person & Technology tools in the assessment process, but also the application of the ATA process model.
6 5 pillars of the ATA process model 5. The role of the psychologist4. The psychotechnologist3. The definition of assistive solution (AAATE – ’03)2. The MPT model1. The ICF’s biopsychosocial modelThe ATA process model is built on five pillars of the disability study and rehabilitation research:The ICF: International Classification of Functioning, Disability and Health biopsychosocial model . Activities and social participation are strictly related to the body functions and structures, so that the individual’s functioning is the outcome of a triadic reciprocal relationship among health condition, environmental factors, and personal factors. According to this outlook of human functioning, the ATA process models service delivery provision in such a way that all dimensions affecting the user’s functioning (health condition and contextual factors) must be evaluated when the analysis of the user’s request and the selection of the AT is carried out by a centre. These dimensions are also criteria to verify the success of a good assignment and AT solution.The MPT model [2, 3]. It contends that the characteristics of the person, milieu/environment, and technology should be considered as interacting when selecting the most appropriate AT solution for a particular person’s use. Moreover, the MPT model overcame the traditional one-way process from provider to consumer involving, for the first time, the user in AT selection. The ATA process borrows a user-driven and collaborative working methodology from the MPT model, fostering a continuous dialogue between user and professional or team of professionals to make manifest different perspectives of the person’s needs and appropriate supports. It models a user-driven process guaranteeing that any activity in AT service delivery centre must find a correspondence to a user action and vice-versa;The definition of an assistive solution stated by the AAATE (Association for the Advancement of Assistive Technology in Europe) from 2003 . The solution for a user provided by an AT service delivery centre must “involve something more than just a device, it often requires a mix of mainstream and assistive technologies whose assembly is different from one individual and another, and from one context to another. We may label it assistive solution” . The assistive solution is the goal of the entire ATA process that, hypothetically, might not require any technological aid, but, e.g., just changes to fit the environment or a blend of use of a device and personal assistance . It is also crucial when pursuing the goal of the assistive solution that the user’s request is taken seriously, often having to explore the user’s request of just a device to capture the user’s real needs. For this reason, the ATA process to relaunch the figure of the psychologist as essential, a pillar of the model, will help guarantee a user-centered evaluation and empower users to make their own choices.The role of the psychotechnologist. The psychotechnologist [7-9] is an expert in both psychology and AT, in particular in Human-Computer Interaction (HCI) and human factors, and he or she analyses the relations emerging from the person-technology interaction by taking into account all the psychological and cognitive components, and the possibilities of adapting and designing systems and services in an adaptable and accessible manner. Because of the characteristics of his or her professional background and training, the psychotechnologist is an ideal professional to coordinate the ATA process in an AT service delivery centre.The role of the psychologist. Although the structure, level of intensity, and services available for rehabilitation vary widely from one area to another whether comparing facilities, cities, states, or countries, nevertheless, there is considerable cross-cultural consistency in the view of the composition of the rehabilitation team , from Singapore  to the USA  and Europe [13, 14]. In this framework the role of the psychologist and psychiatrist is well and universally recognized. The psychologist in an AT service delivery process provides an appropriate psychological evaluation or a precise clinical intervention with the users and/or their significant human context over the course of the whole AT assignment process. We believe that to invest in personal factors represents an important turning point for a successful match between person and technology. Assigning greater importance to personal factors would help dramatically to reduce the abandonment rate of technologies by users [3, 15-24].ATA PROCESS
7 The Assistive Technology Assessment process Phase 1:The user seeks a solutionPhase 1:User data collectionThe Assistive Technology Assessment processPhase 2:Evaluation dataPhase 2:The user checks the solutionPhase 3:Matching processThe ATA process can be read both from the perspective of the user or from the perspective of the center for Technical Aid.[click]Since the ATA is a user-driven process any activity of the staff must to find a correspondence to a user action and vice-versa.The users’ actions of the ATA process can be grouped in three phases.Phase 1 The user seeks a solution for one or more own activity limitations or participation restrictions and seeks assistance from a center.Phase 2 [click]The user checks the solution. The user tries and checks one or more technological aids provided by the professionals in an suitable evaluation setting (Center, house, hospital, school, rehabilitation center, etc.)Phase 3 [click]The user adopts the solution after obtaining the technological aid(s) from the public health system or public/private insurance, receives training for the daily use of the AT and follow-up.The actions of the center can be grouped in four phases.When the user provides data to the center, data are collected and the case is opened and transmitted to the multidisciplinary team.The multidisciplinary team evaluates the data and user’s request and arranges a suitable setting for the matching assessment.The multidisciplinary team, along with the user, assesses the assistive solution proposed, tries the solution and gathers outcome data.The multidisciplinary team evaluates the outcome of the matching assessment, then proposes the assistive solution to the user.When the assistive solution proposed requires an environmental evaluation, the team initiates the Environmental Assessment Process that we will deepen in the segment 3 of this workshop.Phase 4 [click]When the technological aid is delivered to the user a follow-up and on-going user support is activated and the assistive solution is verified in the daily life context of the user.Phase 3:The user adopts the solutionPhase 4:Assistive Technology Provisionand Follow-up of the assistive solution in context
8 The ATA process under the lens of the ICF biopsychosocial model Health condition(disorder or disease)Body Functionsand StructuresActivitiesParticipationEnvironmentalFactorsPersonalWell-beingMPTMedical diagnoses*User driven process **Support & follow up ***Assistive SolutionThe ATA process is embedded in the ICF model and the process describes the complexity of the biopsychosocial model.The ATA process means to guide a multidisciplinary team to provide not just devices but much more: assistive solutions; in order to empower the user and improve the well-being.[click]Now, let me show you how the ICF model fits to the ATA process.The individual functioning and disability of the user are taken into account by the multidisciplinary team that evaluates health conditions of the user.The matching process then aims to support activity limitations and enhance individual functioning.Finally, overcoming a disablement may involve something more than just a device, it often requires a mix of mainstream and assistive technologies whose matching is different from one individual and another, and from one context to another. Therefore, the multidisciplinary team has to take in a serious account the participation restrictions.ICF – biopsychosocial model
9 Limiti e vantaggi di un modello ideale di ATA process La difficoltà di definire un unico AT system delivery La straordinaria varietà di sistemi sanitari influenza in differenti modi le specifiche caratteristiche che delineano ogni singolo Centro.La comunità scientifica sta perseguendo un AT system delivery che sia sempre più individualizzato. Come si usa dire Centrato sulla persona.Vantaggi Emerge come una sintesi di esperienze di modelli regionali.Si condivide un modello teorico e criteri di valutazione.Permette di condividere dati essenziali alla ricerca scientifica.Aiuta a pianificare e valutare politiche nazionali e internazionali.Può aiutare a valutare la qualità dei servizi.This model, therefore, intends to express, in an idealized and essential form, an assessment process carried out in a center for assistive technology provision, since it provides such tools for assessment and the professional skill set that we define “psychotechnological.”However, one of the unsolved problems is the difficulty, already met several times, of defining the features of a center for technical aid. The modelling process of a center for technical aid is difficult if one takes into account the extraordinary variety of systems of regional and national health and social care, both public and private (Müller, 2012).Because of the difficulty of finding an adequate and effective synthesis of the various models proposed by specific national systems of public health and welfare, the scientific community is facing an assistive technology delivery system which will be increasingly individualized, due to the social and cultural diversity of users and the necessary adjustment of the center’s functioning to the local health system. However, it should be noted that this particularization of the model is to clash with some trends that are aimed at promoting, instead, globalization (for example, this occurs both in social and health policies of the European Community and in those of the World Health Organization). The internationalization of a model, indeed, is advantageous since it often emerges as a synthesis of experiences of regional models. Moreover, it offers the opportunity, by sharing a theoretical model and evaluation criteria, to share data essential to scientific research, planning, and evaluation of national and international policies and the verification of the quality of public services.
10 Summarizing the 3 main elements identified in SEGMENT 1 Public National Health SystemPrivate National Health System2 models of AT delivery systems in Western countries The main steps of ATA process from the perspective of both user and Center.Body functions and structures,Activity andParticipation3 components of the biopsychosocial model of disability in ICF embedded in ATA process Please, now take a moment to think about the 3 main elements that I have identified in this workshop Segment 1:2 models of assistive technology delivery in Western countries;The main steps of the ATA process from the perspective of both the client/user and the center for technical aid;3 components of the biopsychosocial model of disability embedded in the ideal model of the ATA process.
11 Question time – SEGMENT 1 If the goal of the ATA process is to model an effective assessment process for providing an assistive solution, why does (in the phase 4 of the ATA process) the Center provides an “Assistive Technology” and not an Assistive Solution?Because in the phase 4 we are referring to the provision of an assistive device, evaluated as needed to reach an assistive solution.The assistive solution is the entire process and the outcome.Let me please conclude this first segment suggesting you a question, as reported in the supplementary paper material you own. The issue regards phase 4 of the ATA process, that corresponds to the steps h), i), and j) of the Centre for Technical Aid’s diagram at p. 4 of the supplementary material.The question is:«If the goal of the ATA process is to model an effective assessment process for providing assistive solution, why is (in phase 4, steps “i” of the ATA process) written that the Center provides an “Assistive Technology” and not an Assistive Solution?».We might discuss about it at the question time.Thank you very much for your attention.
12 Segment 2: Factor 2 Managing the ata process: the psychotechnologist Segmento 2: FaTtore 2 dirigere l’ata process: lo psicotecnologoIn this segment I will present the professional figure of the psychotechnologist with particular reference to the specific contexts of application of the assistive technology assessment process in a center for technical aids.
13 Tra l’utente e la tecnologia: Lo psicotecnologo autonomiainterazioneparticipazioneCaratteristichedella tecnologiaBisogni dell’utenteThe assessment process is critical to future success for assistive solutions, it involves a wide range of disciplines and in some cases the emergence of new interdisciplinary approaches.[click]The psychotechnologist is an expert of Information and Communication Technologies, in particular in Human-Computer Interaction and human factors and analyses the relations emerging from the person-technology interaction.The psychotechnologist analyzes the interaction between the User and the Assistive Technology. The analysis aims to reach a level of autonomy of the person in need.psicologotecnologo
14 What the Psychotechnologist is and is not Why not?Psychotechnologist is not a clinic/dynamic psychologist.Psychotechnologist has a background in (rehabilitation) psychology.Cognitive ergonomistEvaluates the interaction according to a dualistic reciprocity between two poles: the user system and the artifact system (Norman 1983).Why not?Psychotechnologist evaluates the interaction according to a user-AT-milieu holistic model.Psychotechnologist is an expert of assistive solutions.Psychologist (in Center for AT provision)is an expert inpersonal factors;human relationships and communication;psychological assessment and intervention;dynamic biopsychosocial variables.The main role of cognitive ergonomics is to analyze person-artifact interaction in the working environment by taking into account:Both the cognitive and behavioral effects arising from the interaction system;The activities and skills needed to improve productivity and effectiveness; and, at the same timeTo avoid any cognitive or physical overload.[click]The psychotechnologist evaluates the interaction between a person and a technology by following a user-AT-milieu holistic model. Moreover, the psychotechnologist values the importance of one or more technological aids selected for an assistive solution.As dr. Fabio Meloni explained in the segment 2, the professional role of the psychologist in assistive technology service provision focuses on personal factors, human relationships, and communication, connecting the “bio-”, “psycho-” and “social” components affecting the assistive technology assessment process.Psychotechnologist is not a clinic/dynamic psychologist, is not the so called “shrink”, but he or she has a background in psychology, especially in rehabilitation.
15 Cosa fa lo psicotecnologo Strumenti:ATD-PAQUEST,SUMI,IPDA…SistemaTecnologicoBarriere e facilitatori“How does the Psychotechnologist work?”Being a psychotechnologist, I introduce a new mark: “the socio-environment-system” by following the biopsychosocial perspective. In this way, the psychotechnologist aims to analyze barriers and facilitators to obtain the best combination possible.Specifically, the psychotechnologist analyzes the interaction between three different systems:[click]the Person, the Technology and the Environmental factors.The analysis aims to reach a level of autonomy of the person in need (related to contextual factors and technological features and functions).The psychotechnologist verifies if the environmental expectations (such as: family, health and educational’ operators) can meet the user’s possibilities to benefit from the technology.In order words, I explore the related material to find the user’s needs by seeking a proper assistive solution (in cooperation with the multidisciplinary team).With the use of different tools (ATD-PA, QUEST, SUMI, IPDA, etc.), the psychotechnologist leads the team by observing critical issues and problems.This analysis it’s important because the psychotechnology:facilitates the human being’s adaptation to the environment system;forces the users to a cognitive, cultural modification and adaptation;increases the information taken by the human technology interaction;modifies the characteristics and functions of the mind;allows a different synthesis of the information;And re-organizes the relations between the elements of the experience.Sistema-utenteSistema socio-ambientaleProspettiva biopsicosociale
16 Valutazione dati utente e organizzazione del setting; Preparazione del setting;Processo di abbinamento;Valutazione della soluzione assistiva;Supporto e follow-up.STARTCentro AusiliContactUser data collectionSetting set-upMatching process: - assistive solution proposal - assistive solution user-trial - assistive solution outcomeAssistive solution Multidisciplinary team evaluationUser SupportFollow upNOTUser agreementEXITMultidisciplinary team meeting for:- user data valuation and - setting designEnvironmental assessment process (see the Usability and Accessibility evaluation diagram)Assistive Technology Provision12345As you can see in detail in the figure 4 of the supplementary material,[click]the psychotechnologist acts in the following steps.The psychotechnologist analyzes the related material and emphasis any environmental, personal and technological issue (phase 1). In agreement with the multidisciplinary team, I also study the medical case by considering:the individual predisposition to the assistive solutions;previous experiences with AT;the current motivation to use AT;the environmental factors that may affect the matching process of the Matching Persons and Technology (SOTU and ATD-PA).The psychotechnologist prepares the setting and checks if the technologies are working (phase 2).More specifically, the psychotechnologist:checks if the social environment is going to support the solution;checks the equipment that will be part of tests (during the assessment to select some ATs, such as keyboard supports, mouse emulators and communication software, etc.) for example selects portable communicators designed for wheelchair use.The multidisciplinary team, along with the user assesses the assistive solution proposed, tries the solution and gathers outcome data (phase 3-4).Assistive solution proposal: the psychotechnologist offers the user the tested technologies by explaining functions and features.Assistive solution user trial: while the user tests the assistive solutions, the psychotechnologist supervises the interaction (between the user and the assistive technology) by collecting any critical situation.Assistive solution outcome: in this phase, the psychotechnologist discusses with the multidisciplinary team about the observations made during the interaction of the user and technology.When the Assistive Technology is delivered to the user, follow up and ongoing user support is activated. The psychotechnologist, in according by the multidisciplinary team, evaluates the outcome of the assistive solution in the context of use (phase 5).When the assistive solution requires an environmental evaluation, the team starts the Environmental Assessment Process to respect the eAccessibility requirements.
17 Assistec – Austria (Miesenberger, 2006) University coursesAssistec – Austria (Miesenberger, 2006)Corso e-learning;4 moduli e 17 seminari;Diploma in Esperto in Tecnologie Assistive.Modulo 1: FondamentiModulo 2: Conoscenze specifiche sulle Tecnologie AssistiveIn 2006 Miesemberger and colleagues proposed an online e-learning course called Assistec focused on Assistive Technologies, e-Accessibility and e-Inclusion with the aim to provide methods, techniques and guidelines to improve the interaction between disabled users and Information and Communication Technologies by means of Assistive Psychotechnologies. The university course was open to people from different academic backgrounds and provided a graduation as experts in the area of Assistive Technologies.[click]The course has been divided into 4 modules 7 seminars as illustrated:The first module described the fundamentals such as e-learning, medicine and physiology, legislative framework and rehabilitation technologies;The second module focused on assistive technologies for special knowledge;The third module illustrated the process of assortment and provision of assistive technologies related to information and communication technologies;The fourth module showed examples in practice and application related to assistive technologies.Modulo 3: Processi di Assortimento e Fornitura di TA e ICTModulo 4: Tecnologie Assistive in Pratica e Applicazioni
18 Master in Psicotecnologie per Soluzioni Assistive University courseMaster in Psicotecnologie per Soluzioni AssistiveCorso universitario;4 moduli, 1000 h di insegnamento frontale, 500 h tirocinio and workshop;Diploma in Esperto in psicotecnologie.Modulo 1: FondamentiModulo 2: Introduzione alla PsicotecnologiaFurthermore, we propose here an example of a Bachelor of Science university course in Psychotechnology for Assistive Solutions, aiming at providing theoretical and methodological skills that are necessary for the analysis, the evaluation and the intervention on the processes involved in the interaction system between persons and technologies, with a particular attention to disabled persons. Students who successfully complete the Psychotechnology for Assistive Solutions course will obtain a Bachelor of Psychotechnologist.[click]The course is divided in 4 module for a total of 1500 hours including training and workshops, and it will focus on:basics in psychology, healthcare, design principles and legislation;theoretical background of psychotechnology and overview of the evaluation techniques of person-technology interaction;different Assistive Technologies and different application fields;phases and actions for the Assistive Technology assessment process.Please, find further information in the supplementary material.Modulo 3: Elementi di base e avanzati su Tecnologie AssistiveModulo 4: Soluzioni Assistive
19 Summarizing the 3 main elements identified in SEGMENT 2 Psychotechnologist analyzes and evaluates the user-technology interaction system according to a User-AT-Milieu holistic model;Psychotechnologist investigates the biopsychosocial variables of the users functioning.The new professional figure of the psychotechnologistPsychotechnologist analyzes the person-technology interaction by means of a biopsychosocial approach;Psychotechnologist is involved in different crucial phases of the Assistive Technology Assessment process.The role of the psychotechnologistAssistec – Austria;Bachelor of Science in Psychotechnology for Assistive Solutions.University courses for psychotechnologistsPlease, now take a while to revise the 3 main elements that I have Identified in this workshop segment 2:The new professional figure of the psychotechnologist analyzes and evaluates the user-technology interaction system according to a user-AT-milieu holistic model, and investigates the biopsychosocial variables of the users functioning.The psychotechnologist works in different professional contexts according to a biopsychosocial approach and has a crucial role within the Assistive Technology Assessment process;We described two examples of courses for the psychotechnologist education a current e-learning course and a new proposal for a future university course in Psychotechnology for Assistive Solutions.
20 Question time – SEGMENT 2 Does a psychotechnologist have something to do with the method of psychotechnology in the applied psychology proposed by Igor Smirnov to manipulate human mind by means of technology?No, it doesn't! Not at all. As we previously explained, the psychotechnologist does not have anything to do with thought control!In fact, the current concept of psychotechnology is related to a neologism to explain a new professional figure which investigates the psychological and cognitive components involved in the interaction environment, be it either a physical environment or a Information and Communication Technology one.Let me please conclude this segment four suggesting you a question, as reported in the supplementary paper material you own.Although the term “psychotechnology”, with the meaning adopted and introduced in the psychology of rehabilitation, was for the first time introduced by Stefano Federici since 2001, actually, it recalls the same word used by Igor Smirnov (1995) to manipulate human mind by the means of technology.Therefore, it’s possible that some of you may have wondered: “Does a psychotechnologist have something to do with the method of psychotechnology in the applied psychology proposed by Igor Smirnov to manipulate human mind by means of technology?” Think of other words we use: psycho-therapist. Psycho-analyst. Psycho-metrics. Psycho-tropic (having to do with medications).We hope that this segment has removed any doubt about this confusion of terms.Thank you very much for your interest in our work.
21 Segment 3: assessing personal factors in a center for technical aid In the segment 3, I will present the professional functions of the psychologist in a center for technical aid. The main skills of the psychologist will be grouped into two psychological dimensions: expertise on personal factors and ability in the field of human relationships and communication.
22 The Number One Suspect in AT abandonment: Personal factors Philips & Zhao (1993) Predictors of Assistive Technology AbandonmentScherer et al (2005) Predictors of assistive technology useDijcks et al (2006) Non-use of assistive technologyLauer et al (2006) Factors in Assistive Technology Device AbandonmentVerza et al (2006) Evaluating the need for assistive technology reduces equipment abandonmentFederici & Borsci (2011) The use and non-use of assistive technologyFor nearly two decades the scientific literature has given increasing attention to the issue of assistive technologies abandonment. The nature of the phenomenon is complex and this is one of the reasons why the abandonment has been frequently called in different ways: neglect, discard, discontinuity. Each of these terms reflects different ideas about the causes and the modalities of non-use of assistive technologies. However, a significant part of the literature on this topic identifies the lack of consideration given to personal factors as a major cause of abandonment. The early study of Philips and Zhao in 1993 found that three out of four factors significantly related to abandonment – lack of consideration of user opinion in selection, easy device procurement and change in user needs or priorities – were significantly related to personal factors. In the last 7 years, a growing number of scholars have turned their focus on the role of personal factors in the relationship between user and assistive technology.Despite of this, the most important international classification of functioning and disability, the ICF (WHO, 2001), grounded on the biopsychosocial model of disability, has never classified the personal factors.
23 What the personal factors are genderraceagefitness... … … … ?copingself-esteemWhat the personal factors areICF - biopsychososcial modelHealth condition(disorder or disease)Body Functionsand StructuresActivitiesParticipationEnvironmentalFactorsPersonalThe second part of the ICF covers “contextual factors”, divided into two components: environmental factors and personal factors. After more than ten years, the personal factors are not yet coded in the ICF classification, although they are heavily involved in the process of functioning and disability.Personal factors are defined in the ICF as “the particular background of an individual’s life and living and comprise features of the individual that are not part of a health condition or health states” (WHO, 2001, p. 23).[click]They include gender, race, age, other health conditions, fitness, lifestyle, habits, upbringing, coping styles, social background, education, profession, past and current experience, overall behaviour pattern and character style, individual psychological assets and other characteristics, all or any of which may play a role in disability at any level. They also include psychological, emotional and behavioral aspects, such as attribution styles, self-efficacy, self-esteem, emotion, motivation and problem-behaviors.As stated by Ueda and Okawa in 2003, personal factors belong to the objective dimension of functioning.One of the most relevant categorizations focuses on which personal factors are changeable and which are not. This distinction plays a central role since that the team of the centre for technical aid operates not only to turn environmental barriers into facilitators but also to motivate the user/client to do the same on his or her adjustable individual resources.
24 Why the AT Service provision is an expensive process A holistic rehabilitation technology faces several variablesAn effective rehabilitation technology is an expensive processThe rehabilitation technology standard neglect personal factorsWhy the AT Service provision is an expensive processThe variability is an obstacle because it is a costThe ICF imputes the lack of codes for the personal factors to “the large social and cultural variance associated with them.” (WHO, 2001, p. 9) We believe that the extreme variability of personal factors is certainly expensive.[click]Similarly, we know that any truly user-centered process of rehabilitation, that adopt a holistic perspective about the user, is equally expensive. But we also know that every path for an effective rehabilitation is necessarily expensive. A short term business approach to rehabilitation has led to neglect the role of personal factors due to the ignorance on their relevance for a successful outcome and for reducing economic waste. The justification of the ICF regarding the extreme variability of personal factors, therefore, is very weak. We believe that the real reason for non-coding consists in the necessity to do not introduce in the rehabilitation process too holistic variables on behalf of standardization and objectivity.
25 Return on Investment (ROI) in assessing personal factor Matching Aid and Person, financed by the Italian Umbria Region in 2009 Identify the percentage of AT non-use and the users’ satisfaction of AT in a national health system.Federici, S., & Borsci, S. (2011). The use and non-use of assistive technology in Italy: A pilot study. In G. J. Gelderblom, M. Soede, L. Adriaens & K. Miesenberger (Eds.), Everyday Technology for Independence and Care: AAATE 2011 (Vol. 29, pp ).ResultsMean of non-use 18% (good!)Main reason of AT non-use Personal FactorsUmbra Region Aid and Prosthetic Service ProvisionEconomic wasteEconomic waste 2009ROIon personal factorsin Umbria Region=$ 2,000,000Umbria population = 908,000But what is the cost of standardization and how much is the economic waste due to neglect personal factors?A research, carried out between November 2010 and January 2011 in the Umbria Italian region, has shown that in a year, the economic loss due to mismatches between users and technologies is around 1.5 million euros and that this loss amounts to about 4.5 million euros in three years.[click]Data clearly show that the users’ satisfaction of AT and of service providers are strongly correlated to the AT non-use, by suggesting that just a user-driven process of AT assignation process, centered on the user-patient needs and expectations might reasonably prevent the AT non-use and abandonment. The 18% of AT mean of non-use, estimated in this survey, is slightly lower compared to the range of percentages usually reported by international studies, that is rated from 29% to 33%.Nevertheless, the appraisal of the Italian National Health System’s economic loss for AT abandonment remains high.Data shows a strong correlation (p<.001) between AT non-use and the AT users/patients’ dissatisfaction reasons – adjustments and personalization, safety, and comfort. All these variables are codifiable as belonging to personal factors.We can conclude that the return on investment on personal factors in AT assignment in Umbria Region might amount to 2 million dollars.
26 How to invest in personal factors Macro-levelWHO Develop personal factor categories within the ICFLocal-levelEmploy psychologist as expert in personal factorsMeloni, F., Federici, S., Stella, A., Mazzeschi, C., Cordella, B., Greco, F., et al. (2012). The Psychologist. In S. Federici & M. J. Scherer (Eds.), Assistive Technology Assessment Handbook (pp ). Boca Raton, FL, US: CRC Press.Psychologistin a AT service delivery processprovidesan appropriate psychological evaluation or a precise clinical intervention with the user/client and/or their significant human context over the course of the whole AT assignment process.We believe that to invest in personal factors represents an important turning point for a successful matching between person and technology. Giving the importance to personal factors would help to dramatically reduce the abandonment rate of technologies by users. The steps needed to facilitate this investment are, according to our opinion, at least two:WHO should immediately provide for the encoding of personal factors in the International Classification of Functioning, Disability and Health. The psychological variables comprised in the ICF’s personal factors can make substantial differences to the rehabilitation process and, particularly, they play a central role for a service delivery provision.The centers for technical aid should employ more psychologists as skilled professionals in the personal factors. It is reasonable to assume that the lack of importance given to the “systemic” skills of the psychologist in the process of matching the person with technology is largely due to the personal factors non-coding in the ICF.[click]Out of all the professionals comprising the multidisciplinary team, the psychologist is the one who, in terms of curriculum and training, is the greatest expert in personal factors as they are conceptualized by ICF. In an AT service delivery process, psychologist provides an appropriate psychological evaluation and a precise clinical intervention with the user/client and/or their significant human context over the course of the whole AT assignment process.
27 What the psychologist does Identify the user’s personal factors, priorities, preferences, etc.;advocate the user’s request;act as mediator between users seeking solutions and the multidisciplinary team;act as team facilitator among members of the multidisciplinary team;reframe the relationship between the client and his or her family.The international scientific literature has never given a clear definition of the role and competencies of the psychologist in the rehabilitation field.In the ATA process the psychologist’s role and the professional skills of psychologists consist of:identify the user’s personal factors, priorities, preferences, etc.;advocating the user’s request in the user-driven process through which the selection of one or more technological aids for an assistive solution is reached;acting as mediator between users seeking solutions and the multidisciplinary team of a centre for technical aid;team facilitating among members of the multidisciplinary team, and finally;reframing the relationship between the client and his or her family within the framework of the new challenges and limitations and restrictions they face.
28 The role of the psychologist in the ATA process Multidisciplinary team meeting for:- user data valuation and - setting designSTARTCenter for Technical AidContactUser data collectionSetting set-upMatching process: - assistive solution proposal - assistive solution user-trial - assistive solution outcomeAssistive solution Multidisciplinary team evaluationUser SupportFollow upNOTUser agreementAssistive Technology ProvisionUser/client REQUESTUser ActionsRequest to solve activity limitationsRequest to solve environmental restrictionsProviding history (medical, rehabilitation, support use) and psycho-socio- environmental dataUser subjective evaluation of technological aidsUser evaluation of assistive solutionShort/Long-term useEffectivenessEfficiencyUsabilityPersonal, emotional, social, comfort with useSubjective well-being-BenefitAssistive Technology obtained: public health system or public/private insurancePsychologist’s roleADVOCATEIDENTIFYFACILITATETEAMThe role of the psychologist in the ATA processIdentify Advocate Mediate Facilitate Reframe MEDIATELet me show you in details what the psychologist should do within an Assistive Technology Assessment process.The psychologist should identify.During the user data collection step, the psychologist analyzes the clinical and psychosocial data in order to identify the greatest number of personal factors that are relevant in matching the user with technology. In addition, the psychologist will identify user’s preferences and priorities in relation to the objective to be achieved through assistive solution.[click]The psychologist should advocate.During the multidisciplinary meeting, the clinical psychologist’s tasks is to emphasize the unique and peculiar aspects of the case represented by the user/client in terms of personal factors and of his or her human and relational context of life.During the multidisciplinary team evaluation, the psychologist advocates the user/client’s request guaranteeing a user-driven assignation process through which the selection of one or more technological aids for an assistive solution is reached. Active listening, empathy, ability to reformulate in a shared language the user/client requirements are the main instruments employed by the clinical psychologist in this step. Advocating user’s requests is a psychologist’s task also in the follow up step.The psychologist should mediate.As Brown and Gordon (2004, p. S13) claim: “Measurement and assessment, occurring within both research and clinical service contexts, typically involve an imbalance of power between professionals and persons with disabilities. Power is evidenced in who controls decisions about measurement and whose perspective—the subjective values of the measured person or the objective or normative values of the measurer—is given primacy”. An assistive technology assessment process could amplify the relationship’s imbalance, since the presence of a multidisciplinary team, in which each professional carries out his or her values and preferences, might exponentially tend to disempower the disabled person’s point of view. Consequently, the psychologist should mediate between user seeking solution and the multidisciplinary team during the multidisciplinary team meeting and the assistive solution multidisciplinary team evaluation.The psychologist should facilitate.As an expert in human relationships, the psychologist plays a key role in making easier connections between the different perspectives of the team professionals.The psychologist should reframe.Families and caregivers also have expectations about AT assignment, overestimating or underestimating the outcomes, which will condition their relationship with the disabled user and the professionals.In fact relatives’ representations of disability can help or limit the disabled person’s independence, influencing their expectations of his or her abilities. During the user agreement step and the support and follow up phases the psychologist might help the family and/or caregivers to reframe their relationship with the user.REFRAME
29 Summarizing the 3 main elements identified in SEGMENT 3 Age;Self-efficacy;Predisposition to technology use.3 main personal factors within a list of functional factors developed from the ICF Analyse user’s request;Expert in human relation;Dynamic comprehension of the biopsychosocial variables.3 main competencies of the psychologistIdentify // Advocate // Mediate // Facilitate // ReframeThe role of the psychologist in the ATA processPlease, now take a while to revise the 3 main elements that I have Identified in this segment 3:3 main personal factors within a list of functional factors developed from the ICF;The 3 main competencies of the psychologist; andThe role of the psychologist in the ATA process.
30 Question time – SEGMENT 3 Why is the engineer not an expert in personal factors?The engineering curriculum does not typically include this.Because knowing about personal factors is not equivalent to knowing subjective dimensions and individual functioning.Theoretical acknowledge of personal factors does not reveal the psychological and existential side of the individual’s functioning.Let me please conclude this second segment suggesting you a question, as reported in the supplementary paper material you own. According to a folk psychology, all of us own a theory of other minds. Therefore, to certain extend, all of us believe to be an expert in personal factors. And, to certain low level, it’s true. Consequently, by taking into consideration that in the services for assistive technology provision, the majority of the professionals are engineers, one might wonder: Why is an engineer not an expert in personal factors? In other words: Why do we need to employ psychologist?Thank you very much for your attention.
31 Segment 4: assessing environmental factors in a center for technical aid In this fourth segment I will present a model for evaluating the impact of the environment within the Assistive Technology Assessment process. This model adopts a holistic outlook that integrates the three dimensions of accessibility, sustainability, and universal design.
32 Why assess the environment Health conditions are affected by environmental factors(WHO, 2011, World report on Disability)AT abandonment is affected by environmental factors(Philips & Zhao, 1994; Scherer et al. 2005; Federici & Borsci, 2011)The first World Report on Disability recently published by the WHO (2011) states that “Data on all aspects of disability and contextual factors are important for constructing a complete picture of disability and functioning. Without information on how particular health conditions in interaction with environmental barriers and facilitators affect people in their everyday lives, it is hard to determine the scope of disability.”[click]Moreover, several surveys on assistive technology abandonment collected a large amount of data about the importance and effect of personal and psychosocial factors on the non-use and discontinuance of assistive technology use.
33 What the environment is in the ATA process Any context in which the AT is used by a personSocial and natural environmentand artifactsPersonal FactorsICF - biopsychosocial modelHealth condition(disorder or disease)Body Functionsand StructuresActivitiesParticipationEnvironmentalFactorsPersonalDefinitionEnvironmentalFactorsPersonalICFContextual FactorsAccording to the ICF biopsychosocial model of disability, shown in the slide,[click]the environment and the personal factors belong to the Contextual Factors.Therefore, we define the environment in the Assistive Technology Assessment process as any context in which the AT is used by a person. According to this definition the environment refers to the world in which people with different levels of functioning must live and act (WHO, 2011, p. 5).The dimensions of the context in which the AT is used are:The social and natural environments and human artifacts (i.e., products and technology, the natural and built environment, support and relationships, attitudes and services, systems, and policies).Personal factors, such as age, sex, race, motivation, and self-esteem, influence how much a person participates in society.These dimensions can be either considered as facilitators or barriers.Dimensions
34 How to assess environment Environment of useFacilitator (AT)BarriersICF ConstructsOutputUser’s PerformanceAccording to the ICF, “facilitator” and “barrier” provide a way to weight how muchelements of the environment of use (context) fostering or preventing person’s performance. Of course any AT should be considered as a facilitator since it should be improve the user’s performance.
35 How to improve the user’s performance AT facilitator Measures of Environment and AT impactMirza, Gosset, & Borsci 2012Decisions for Improving User’s PerformanceModify EnvironmentModify ATModify AT and EnvironmentEnvironment of useAccessUseSustainableMirza, Gosset, and Borsci (2012) have pointed out three measures of environment and assistive technology impact on the user’s performance:Accessibility (Access): It measures the level of environmental characteristics to permit entrance, exit, and internal movements. This measure also predicts how many changes are needed for rendering accessible the environment in use.Universal design (Use): It measures how much an environment and a human product are designed for all.Sustainability (Sustainable): It measures how much an environment and AT are adaptable over the time to person’s changing needs, with minimal impact on natural environment and economic maintenance.[click]These three measures guide professionals to make decisions in order to:Modify the environment;Modify the AT, or change the current AT with another one;Modify both AT and the Environment.
36 Assess the match between AT and environment AccessibilityThe three measures of the accessibility, universal design, and sustainability capture three perspectives on the interaction between person and assistive technology in an environment of use.[click]The goal of practitioners (e.g., architecture, engineer, psychotechnologist, ergonomist, etc.) is to reach an “ideal fit”, that is, matching these three dimensions.Nevertheless, previous researches (Gossett et al., 2009) has shown that a “perfect fit” remains a ideal goal. Instead, in most situations there exists a tenuous relationship between these three desired features pulling the design solution in divergent directions (e.g., more accessible than usable and sustainable).The adopted final solution eventually reflects a trade off between the three dimensions of accessibility, sustainability, and universal design as the following slide shows.Ideal fitUniversalDesignSustainability
37 Assess the match between AT and environment The dimensions of accessibility, sustainability, and universal design each exists along their own continuum.Each decision about the environment or about the AT (or both) can be evaluated in terms of universal design, accessibility, and sustainability, falling into various places on the three continua.The evaluation on the three continua can help to focus a decision on a critical deciding factor for improving the person performance.[click]
38 How to assess accessibility General guidelinesPhysical access lawsLocal policiesThe practitioners may assess accessibility by using general guidelines and national physical access laws for analysing the barriers that prevent the interaction between AT and users in the environment of use.A knowledge of local policies governing accessibility will also help determine whether the AT and environmental modifications will be publicly or privately funded, that is a key factor in determining the feasibility of the proposed assistive solution.
39 How to assess Universal Design Principle of UDEffectiveness, efficiency and satisfactionThe practitioners may assess universal design by using the design principle (e.g., as the seven principles of universal design of the Center for Universal Design, 1997) for considering the users’ needs who may require assistive solutions to fully participate in a given space.At the same time practitioners have to consider how to assess the effectiveness, the efficiency, and the satisfaction perceived by the persons when they use AT in different environments. This is especially important when an assistive solution is proposed for communal settings, such as schools, and it involves multiple users in various capacities, such as students, parents, administrators.
40 How to assess sustainability Sustainable standards / principlesPerson’s needs over the time (changing)Impact AT-Environment (cost of maintenance)Practitioners assess the sustainability of the physical, social, economical, ecological and temporal contexts during the Environmental Assessment process.The sustainability can be assessed by using specific standards for physical environments, as the Leadership Energy and Environmental Design (LEED; U.S. Green Building Council, 2011). At the same time, it is important to consider not only how much the solution is ecologically sound and environmentally-friendly, but also on how much the solution will meet the user’s changing needs over a period of time, ideally a life span.
41 Environmental Assessment Process Change the environment Center for Technical AidCheckthe matchEnvironment data collectingSTARTEnvironmentUniversal designAccessibilitySustainabilityAT/end userContactUser data collectionMATCHEND EXIT TOYESMultidisciplinary team meeting for:- user data valuation and - setting designNOTNOTCheck theimpactModify the environment in use(Mod–Env)Proposal of a newmatching processor strongpersonalization (Prop–nMP)IFIFSetting set-upMatching process: - assistive solution proposal - assistive solution user-trial - assistive solution outcomeImpact of environment modificationImpact of a new matching processClimateImpactAssistive solution Multidisciplinary team evaluationMod–Env ResultsProp–nMP ResultsIn the ATA process a specific Environment Assessment procedure guides multidisciplinary team to effectively evaluate and determine a best assistive solution for the user’s needs. We can identify three main phases of the environment assessment process:[click]The first phase consists in Checking the match: The practitioners assess the environment impact in supporting or obstructing full participation for the user.IF there is a match between the environment, the user, and the AT, the assistive solution is achieved and the environment assessment process ends.While, IF a match does not occur, it is necessary to estimate the impact of the possible modification to the environment or to the AT.In the phase two, practitioners have to check the economical and socio-cultural impact of the modifications to the climate. The modifications can regard the environment, the assistive technology or both.[Click]On the base of the impact analysis, in the phase three, practitioners can take one of the following decisions:Suggest the modification of the environmentClick]– In this case, the ATA process restarts from the multidisciplinary team’s evaluation for a new or the modified assistive technology. The match between the assistive technology and the user only requires a minimal environmental adaptation.But the practitioners can decide do not modify the environment by the modification of assistive technology.– In this case, the ATA process restarts with a new multidisciplinary team meeting in order to discuss:The cost-benefit of assistive technology modifications;The cost-benefit for identifying another assistive technology. In this case the process restarts from the beginning of the assistive technology assessment process.Finally the practitioners could decide to modify both the assistive technology and the environment.– Also in this case, the ATA process needs to restart with a new multidisciplinary team meeting in order to discuss costs-benefits of the proposed modifications.NOTTakea decisionMod–Env < Prop–nMTMATCHProp–nMP< Mod–EnvIFIFEXITUser agreementIFProp–nMP= Mod–EnvNOTNOTAssistive Technology ProvisionResultsChange the ATEND EXIT TOChange bothUser SupportChange the environmentChangeAT andenvironmentChange the ATChange EnvironmentFollow up
42 Summarizing the 3 main elements identified in SEGMENT 4 Accessibility removing barriers and grant access;Universal Design effectiveness, efficiency and satisfaction;Sustainability environment adaptation with minimal impact.3 measures of the environment and assistive technology impact on user’s performance:Modifying the environment;Modifying or changing the AT;Modifying both the environment and AT.Identify the AT environmental assessment as a decision-making process for:Check the Match between the AT and the environment of use;Check the Impact of environment and AT modificaton;Take a decision on the base of the advantages of different kinds of modification.3 main phases within the Environmental Assessment process:Please, now take a while to revise the 3 main elements that I have identified in this segment 4:We have defined 3 different measures of the environment and assistive technology impact on the user’s performance: accessibility, universal design, sustainability.We have proposed the assistive technology environmental assessment as a decision-making process aimed at modifying the environment, the assistive technology, or both for a successful matching between user and technology.Finally, we have shown 3 main phases within the environmental assessment process model.
43 Question time – SEGMENT 4 Must we restart the Environment Assessment process when the result of the process suggests a need to modify or completely change the AT?Yes, you should. All the steps of the Environment Assessment decision-making process might need to be repeated when a modified or a completely new AT is proposed by the multidisciplinary team.Let me please conclude this fourth segment suggesting you a question, as reported in the supplementary paper material you own.The goal of practitioners (e.g., architecture, engineer, psychotechnologist, ergonomist, etc.) involved in an environmental assessment never replace the multidisciplinary team assessment for an assistive solution. The environmental assessment, when needed, supports and integrates the assistive technology assessment process carry out by the multidisciplinary team of a service for AT provision. In light of this, I invite you to reflect on this issue: «Must we restart the Environment Assessment process when the result of the process suggests a need to modify or completely change the AT?»