Community Living & Assistive Technology: 
The Reality and the Promise 
Delaware's Path toward a Comprehensive AT Access Infrastructure

Beth Mineo Mollica, Ph.D.
Delaware Assistive Technology Initiative
Center for Applied Science and Engineering
University of Delaware
Assistive Technology Is Key To...Independent and safe community living

What Is Assistive Technology?
? AT Device
	Any item, piece of equipment or product system, whether acquired off the shelf, modified or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.
[20 U.S.C. Chapter 33, Section 1401 (25)]

What Is Assistive Technology?
? AT Service
	Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.
[20 U.S.C. Chapter 33, Section 1401 (25)]

Is AT getting to everyone who might benefit from it?
NO!
? Awareness challenges
? Expertise challenges
? Funding/policy challenges
? Population specific challenges
Awareness Challenges
? Unaware that tools exist to address challenges to independence
? Unaware of how to access tools and related supports
? Example: maintaining the checkbook

Funding/Policy Challenges
? Varied sources of support for AT access
? Be prepared for confusion and complexity
? Denial ain't just a river in Egypt
? Devices and services
? Ownership issues

Expertise Challenges
? May need assistance in:
? evaluation of need
? device selection and "try out"
? device procurement/purchase
? Specialized expertise needed in some situations
? limited number of qualified providers

Population-Specific Challenges
? Older people may have:
? Different perspective on "disability"
? Technophobia
? Limited contacts and networks

Population-Specific Challenges
? Individuals with cognitive limitations
? Technology design issues
? "Worthiness" issues
? Limited self-advocacy/self-determination
? History of learned helplessness

Delaware's Experience
? Precipitating Factor:
  Individuals with MR living in community residences had communication devices but didn't have access to them
? Work group convened to figure out why
? Many factors hypothesized
? Began by assessing nature/extent of the need for AT

Study #1
? Representative sample of Division of Mental Retardation caseload (N=50)
? AT needs screened( 80% referred for further evaluation
? Evaluation driven by screening results
? Consumer, family, & provider involvement
? Up to 4 disciplines involved
? Average cost of evaluation = $360

Study #1 Results
? 68% of study population had an immediate need for AT devices and services
? Projected cost for addressing needs = $2,300 per person (n=34)
? Costs averaged across entire sample = $1,550 per person
? Estimates included devices and services to meet immediate needs only

Study #2
? Study #1 participants followed for 15 months to:
? examine the extent to which their needs were met
? identify elements that either facilitated or hampered AT access

Study #2 Results
? 74% of those who needed AT had at least some of their device/service needs met.
? 91% continued to have unmet needs.
? Many barriers to AT access were identified:
? inadequate communication among team members
? uncertainty regarding policies, procedures, and resources
? lack of access to equipment for trial use periods
? limited availability of staff qualified to support AT implementation
Study #2 Results
? Contrary to popular belief, lack of funding resources was not a primary barrier. 
? Confusion about how to access that funding was the problem.
? Those residing in the state institution (Stockley Center) enjoyed much better AT access than those living in the community because of Stockley's investment in:
? staff development (skill & attitudes)
? an equipment inventory
? the development of policies/procedures streamlining AT access
? Those with a successful AT outcome had the benefit of an advocate concerned with timely and appropriate acquisition of devices/services.

Study #2 Conclusion
? The challenge for Delaware's MR/DD system was to build a sufficient AT access infrastructure combining:
( qualified providers
( technology availability
( coordination
( responsive and consistent policies and practices
( enabling attitudes

Subsequent Initiatives
? Development of the Comprehensive Guide to AT Resources for DDDS Clients in Delaware
? Clarification of policies related to AT access through Medicaid, DDDS, Medicare, private insurance, and other sources
? Establishment of AT Recycling Center
? Incorporation of AT screenings into annual planning process
? Commitment from state agency to #s of clients screened and staff trained

Gaps in Support Remain
? Private insurance far less responsive to AT requests than DE Medicaid
? Many do not have Medicaid coverage
? Many types of AT still not funded routinely by DE Medicaid:
? home modifications
? vehicle modifications
? aids for hearing and vision
? environmental control systems
? Community service provision still far less comprehensive than institutional service provision, but that will change with implementation of new initiatives

Recent Developments
? Expansion of infrastructure improvement project to include entire state Department of Health and Social Services, as well as other key state agencies and consumer groups
? Real Choice Systems Change grant awarded to DE to support this initiative

Grant Elements
? Needs analysis
? Comprehensive awareness and training campaign
? Streamlined access process
? Information dissemination
? AT access alternatives
? Capacity building
? Data collection/tracking/evaluation

Assistive Technology Act of 1998
? Supports states in sustaining and strengthening capacity to address AT needs of individuals with disabilities
? Support investment in technology across federal agencies and departments
? Supports micro-loans programs for individuals wishing to purchase AT
? State Programs - focus on capacity building and advocacy activities to assist states in maintaining permanent, comprehensive, consumer responsive, statewide programs of technology-related assistance
? State requirements
? Public awareness about availability and benefits of AT
? Interagency coordination to improve AT access
? Technical assistance and training
? Outreach to underrepresented populations
? State optional activities
? Alternative financing systems
? Technology demonstrations
? Funding information
? Information-and-referral
? Interstate activity
? Create public-private partnerships
? Broad mandate - target population is all persons with disabilities
? all ages
? all disabilities
? all service systems
? All states, DC, Puerto Rico, and outlying areas have funded projects...for now
? 23 states will lose all funding if Congress does not act quickly

For AT Act State Project Information...
Association of Tech Act Projects (ATAP)
atap@ataporg.org
(217) 522-7985
RESNA Technical Assistance Project
www.resna.org/taproject/at/statecontacts.htm(703) 524-6686
For more information...
Beth Mineo Mollica, Ph.D.
Delaware Assistive Technology Initiative
University of Delaware
(302) 651-6836 (voice)
(302) 651-6794 (TDD)
(302) 651-6793 (fax)
mineo@asel.udel.edu (email)