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The Quebec model of services: An access system to adaptive technologies fundamentally different

Jean-Marie D'Amour
Computer Adaptive Technology Specialist
Institut Nazareth et Louis-Braille
1111, St-Charles Street West,
Longueuil (Quebec) Canada J4K 5G4
Email: jmdamour@inlb.qc.ca 

Carole Guillemette
Program Coordinator
Institut Nazareth et Louis-Braille
1111, St-Charles Street West,
Longueuil (Quebec) Canada J4K 5G4
Email: guillemc@inlb.qc.cao

In these times of globalization and frontier lowering, it is surprising to see how other social organization have developed services systems that are sometimes very different. We wish to present today a model of services, which has been working satisfactorily for twenty years in the province of Quebec, Canada. We would like to talk about its characteristics, its advantages but also about its drawbacks. We have learnt a lot from other people's experience and we believe that you could likewise learn from our experience.

The first characteristic to fundamentally influence the establishment of services is the fact that there has been, in Quebec, since twenty years, a government program that loans technical aids to handicapped persons at no cost. As opposed to many other similar programs, the Quebec program absorbs 100% of the cost of purchasing, repairing and upgrading aids. As far as visual disability is concerned, this program as become accessible to all ages and all conditions in a progressive way even if for certain types of aids, such as computer aids, the program is more generous for the students or working people than others.

These aids are paid by Régie de l'assurance-maladie du Québec as all other medical costs. Allotment is however prescribed by a multidisciplinary team from an acknowledged rehabilitation center.

Persons eligible for the program are those whose visual acuity in each eye is less than 6/21, or whose visual field in each eye is less than 60° in the 180° and 90° meridians after correction by appropriate ophthalmic lenses (eye-glasses or contact lenses, but not special optical systems or additions of more than 4 dioptres).

A list of technical aids is established by Government’s regulations and revised every three years in average. This list is not exhaustive and is not always up to date if we consider the very fast evolution of technologies. However it is often possible to find other organizations to fill up this gap.

The government of Quebec as also installed during the last twenty years rehabilitation centers public network in all the regions of the province. Two of these centers offer more highly specialized services known as "national", including allotment and training of Braille and speech computer aids and a guide-dogs orientation & mobility program.

All rehabilitation centers strongly integrate the allotment of technical aids, the learning of their use and the acquirement of all techniques and skills required for a complete functional rehabilitation. They serve the same population as the technical aid’s program mentioned above.

Within framework of an individualized intervention plan established from handicapping situations encountered by the person, we can proceed to the allotment of technical aids. Training to master required functional skills is then given, generally on an individual basis. The purpose of this training is to enable the person accomplish personal, social, academic or professional activities.

Concerning computer aids training, we tend to enable the person to perform basic tasks in Windows and word processing. For other tasks such as email, research on the web, database management and home made software in businesses, etc., training can be given to a group if a group of person having the same needs can be formed in a reasonable laps of time according to the person’s need. Otherwise this training is offered on an individual basis.

In order to serve the whole population of Quebec (7 millions inhabitants for about 20 000 clients of all ages over a potential of 60 000 persons having a visual disability) we have close to 25 specialists in computer-adaptive technologies. Continue training programs are regularly organized to keep track of the fast evolution of knowledge and abilities in this changing field.

To maintain these training services we must also conduct research and development activities. This will help us to evaluate new available products, come up with training tools in constant outgrowth and work with other partners in the private sector to French adaptation of North American or European products and to the development of entirely new and better adjusted products to our client’s needs. Two of these Quebec partners are: Tecso for training tools development and Visuaide for a large range of products.

Training is generally provided in the person’s environment in order to adequately and concretely fulfilled the real needs in the real world.

Once the training is done the person can access any follow up required by sometimes very rapid evolution of her situation.

A group of 25 specialists in adaptive computer technologies, even though half of them spread over the province, allows sufficient interactions and energy invested in research and development to build a strong expertise, independent from dealers.

Because we're talking about a public system, the bureaucratic process is often heavy and complex with all kinds of delays and complications, which make the work of specialists more demanding and waste their time. Direct impact on users is minimized as much as possible but an indirect impact is undeniable.

Because of the slow process of the revision of regulations, the program is always behind reality of needs and available technologies to answer those needs. Other organizations must be approached to fill these gaps.

The specialists in adaptive computer technologies are unionized and permanent and the staff slowly changes. On a long term this could be a factor of resistance to improvement.

The fact that all technical aids are free and available creates for some clients a tendency to accumulate equipment, which they could easily do without in other context, and to disperse their training and mastering efforts in to many directions at once.

Since training is free, there's no natural flushing process on the users who cannot control the use of their equipments. This problem results sometimes in an endless and useless training.

1. Universal access to technical aids.
2. 
   
3. Users benefit from an independent counselor.
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5. A complete public system cohabits with private initiative.
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7. Free quality training.
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9. At home, at school and at work training.
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11. A permanent support after training.
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13. A strong and independent expertise.

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