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Corporate Assistive Technology – Returning People to Work in a Corporate Environment

W. Skip Simonds
Kenneth Mitchell, Ph.D.
UnumProvident Corporation
Portland, ME

Starting with the broadest view of disability, one is led to make finer and finer discriminations in order to develop a coherent appraisal of the needs of an individual with a disability and potential solutions to functional impairments. Disability in the broadest view is any functional impairment regardless of type, extent, or duration. Such a perspective covers every deviation from "ableness" from poor but correctable eyesight to high cervical events; from mild inability to concentrate to traumatic brain injury, and, of course, much, much more. While one can develop an all-encompassing view of disability, it is impossible to conceive of one single solution to all functional impairments. For every different impairment, there is the potential for a corresponding functional impact. Within a single impairment, there is a range of functional impact depending on the severity of the impairment. Finally, regardless of range, impairments can last from moments to months to lifetimes, and solutions must take duration into account to be usable.

To this obvious bore down list, type-extent-duration, a fourth level must be added which has been largely ignored to date: venue. The purpose of this paper is to outline the effects of location and application on the facility of utilization of existing AT products and the conceptualization and development of newer and more effective products for a specific range of applications: returning people to work with the corporate environment.

Employers, especially corporate employers, recognize the cost of lost workdays due to disability as well as the individual affected by impairment. From the employer’s point of view, the cost of lost workdays reduces the organization’s productivity, profitability, and competitiveness as well as the human costs of the loss of a valued colleague. While the average American is between the ages of 35 and 65, he or she runs a 30% risk of suffering an impairment of 90 days or longer in length. What’s more, each year more than 750,000 Americans experience injuries or illnesses that keep them out of work for 5 months or longer.

Catastrophic disability has been the focal point of much of the development in new assistive technology products. The effects of impairment on the individual’s ability to conduct the major activities of life have served as a lightning rod for creative efforts. Necessity is the mother of all invention, and nowhere more than in the foundational efforts to see people create, maintain, and extend independent living situations.

However, not all impairments are catastrophic, not all durations are life long, and not all needs warrant unlimited resources in their solution. Gaining quickly in the hierarchy of needs is the need for flexible, inexpensive, readily available solutions for non-catastrophic, non-permanent functional impairments. And within that subset, there is a need for solutions that can be applied primarily in the work place.

The Americans with Disabilities Act, Title I creates a mandate for employers to provide their employees with a "reasonable accommodation." This mandate placed a socially conscionable responsibility on the employer to take the initiative in response to a bone-fide request for an accommodation from an employee who has a disability, is regarded as having a disability, or has a record of having a disability. However, not all solutions available lend themselves to the corporate environment. And, contrary to expectation, this is more true with larger corporate employers than with smaller.

Because of the predominant emphasis on individually conceived solutions to catastrophic impairments, people don’t get the concept of corporate assistive technology without help.

Product salespeople see it as individual solutions sold by the 10 pack. AT consultants see it as multiple single clients located in a protected environment. End users see it as no different than individual solutions. Even corporate sponsors of internal AT or case management programs shrug their shoulders and don’t get it. Barriers to the successful implementation of any assistive technology in a corporate setting orbit around three points: products, training, and technical support. The products needed by corporate AT programs fill largely different needs than those for the individual. The training required to attain proficiency is different in both type and quantity than that required by individual AT users. And the degree of sophistication in technical support exceeds the need of the individual user and is directly proportional to the size of the corporation.

Issue:

Corporate AT is based on three groups: stay at work, return to work, and bring to work. Individual AT is based on the individual, usually in a bring to work situation. Corporate AT is work focused. Individual AT is impairment focused. Corporate AT is partially therapeutic and partially preventative. Individual AT is almost wholly therapeutic. Corporate AT demands the solution fit the situation Individual AT assumes the situation can be changed to fit the solution

Thoughts:

This suggests that the aims of corporate AT are different from those of individual AT. Many of the solutions in the AT field have been developed with the severely disabled in mind. While the corporate world is interested in putting the severely disabled to work, they are more concerned with helping the current employee return to work, or helping to prevent that employee from leaving work in the first place. I say "more concerned" because, understandably the corporate commitment is to the employee that is already working for the company rather than one that is not. This "on the job" focus for AT translates to a need for solutions for the mildly disabled and injured more than to the severe, although there is that need, too, but to a lesser extent. The very best corporate AT is preventative, catching the injury while it is still acute, before it becomes chronic. Most individual AT is not considered until after the chronic stage is reached.

When the AT in question is software, the corporate situation is further complicated. The marketplace assumes the individual user is free to upgrade operating systems, enhance hardware, or buy a new system altogether, and generally do whatever is necessary to change the situation to leverage the value of the software. Because corporate systems are frequently networked, tied to legacy systems, and use older versions of operating systems and software; it is the AT solution that has to give. It frequently has to be modified, tweaked, and/or pruned to work in an older environment because the environment is relatively concrete.

Training:

Issue:

Corporate AT is implemented in partnership between the corporation and the individual. Individual AT is implemented almost entirely by the individual.

Thoughts:

The motivation to learn and apply what is learned is very different. On a basic level, AT is an expense born by the corporation. However, the individual AT user either has to pay their own way, or has had to jump through hoops to get funding. Corporate training is frequently, "cook until done" at no cost to the employee while the individual user is paying by the hour for training. The corporate user already has a job while the individual user is trying to learn skills to get one. The motivations to learn and use the technology are, therefore, quite different. Training systems, and even original system design, must reflect these differences.

Technical Support:

Issue:

Corporate AT looks for common solutions to multiple problems. Individual AT looks for unique solutions. Because of security concerns corporate AT requires a support infrastructure. Individual AT depends on the savvy of the individual user. Corporate AT requires a multiple location solution and support. Individual AT does not.

Thoughts:

With a corporate emphasis, common solutions, integrated support of systems, and portability are critical issues. Too often the delivery mechanisms that drive the individual AT market do not meet the needs of the corporate market. Individual focus, stand alone solutions, unique applications pepper the individual market. None of these appeal to the corporate sponsor who needs more universal solutions. While no one is advocating a corporate "one size fits all" program, there is a need for consistency in the application of AT solutions. This is especially true when 1) corporate security makes individual "tweaking" of systems difficult or impossible, 2) corporate operating systems are server based or server oriented, a dynamic not found in the individual field, and 3) corporate applications (like a mainframe emulator) are often not anticipated by product developers and consultants with an individual focus.

General Discussion:

All of this cries for the development of a corporate approach to AT. Such a paradigm shift will not come without effort because what the market is providing, in this case, has been determined by historical, not future, needs. Why is the status of the market place important? Because…

"The status of the marketplace determines our potential to deliver timely solutions that truly meet the needs of the individual and the corporation without sacrificing one for the other."

At present, the solutions being generated by the marketplace are dominated almost entirely by the individual paradigm. Even in the corporate setting AT is delivered to the user not the corporation. Currently, the marketplace does not recognize the differentiation between individual and corporate needs and, therefore, has not responded with any corporate solutions. Why this is so can be explained on many different levels. At the forefront is that corporate America itself has not recognized its own need for a corporate solution. All too often, it is too easy to accept the injury or disability as a final state and to use short and long term disability insurance, both public and private, as the "solution". Once the individual is out on claim, it becomes their responsibility to rehabilitate themselves, and the more aggressive among them seek out their own solutions and develop their own technology. For example, a recent survey of over two hundred blind or visually impaired people using screen readers determined that more than one in five were AT consultants or providers.

This one statistic goes a long way in describing the state of the marketplace at this time: cottage industry. Disabled individuals, their relatives, or associates develop unique solutions for the one, and the marketplace snaps up any solution tossed into the void. Even larger corporate developers tend to focus on disability specific, single user products. Unique solutions abound. Corporations, especially larger corporations, spend their resources trying to make these individual solutions work in the multi-user environment, too often with limited or no success.

Currently in the marketplace, there are many individual AT consultants and a corporation could, if they chose to, cobble together a network of the individual consultants in each of the various locations that need accommodations. This is not a good solution. While we might be able to find a consistent level of expertise in each of our markets, it is questionable whether the application of AT would be uniform. Ongoing support is also problematic given the difficulty of maintaining unique hardware and software in a corporate IT setting. It is highly unlikely most individual consultants would have the technical expertise to troubleshoot problems. Corporately it is as important that the consultant knows the corporate system as they know their own products. And there is some question as to the independence of each of these consultants to offer truly appropriate solutions. Many offer only one or two products or specialize in only one or two types of disability. To someone who has a hammer every problem is seen as a nail.

Conclusion:

What is needed is not the reinvention of the wheel, but the re-framing of a paradigm. Corporate users of assistive technology are not different from their individual counterparts. In fact, most are individual users when not at work. However, the constraints that corporate users work under are far more stringent and demanding than those who work at home.

Corporations, especially large corporations, are viewed as having deep pockets. What is unreasonable for the small employer is well within reach of the large corporate employer if all one looks at is dollars. However, more often than not, cost is not the issue. Applicability, flexibility, supportability are. The corporation becomes the partner of the impaired employee. But that facility of that partnership is often limited by elements of the environment within which that partnership occurs. As noted, this is especially true in the computing environment.

With a change in paradigm, developers can begin to design operating system flexibility into their products from the ground up. Often, with a desire to provide a comprehensive product, developers paint themselves into a technological corner by producing software that is unnecessarily complex, prone to failure, and rigid in configuration in order to provide the most in-depth solution possible. In the corporate environment, because it is significantly comprised of the marginally impaired, a less complex, and therefore more stable and fluid configuration would meet the need. If developers realized the need, they would develop the product. It’s a reverse of the Field of Dreams: if the corporations come, they will build it.

Here is an incomplete, but provocative grocery list of considerations for the disability services community:

First, from a delivery and support perspective, as corporations become more diverse in location but more centralized in their IT systems, there is a huge need for a multi-state, multi-discipline presence for sales, support, and training. Individual consultants can enter this market by developing business relationships with other consultants in other metropolitan areas. Second, consultants who specialize in products responding to a single or tight constellation of disabilities can become more familiar with and begin to offer more diverse products and services for a wider range of impairments. Think AT not impairment. Finally, all consultants can become more knowledgeable about corporate computing platforms, server based environments, and various corporate security systems. Press developers to modify existing products to work with servers, legacy systems, mainframes, etc. With this as a starting point, the way is opened for a wider, more creative consideration of the corporate assistive technology user.

William W. Simonds, MA has over 25 years of management experience in medium to large corporations. Prior to joining UnumProvident in 1998, he was Director of Assistive Technology Programs for L. L. Bean, Inc. For the past year, he has been the primary program developer for all assistive technology programs across UnumProvident.

Mr. Simonds is a member of RESNA (The Rehabilitation Engineering and Assistive Technology Society of North America) and AAES (The Association of Access Engineering Specialists). In addition, he has provided consultative input to companies such as Microsoft and IBM on a wide variety of assistive technology development issues.

Kenneth Mitchell, Ph.D. received his Ph.D. from the Pennsylvania State University and served for seven years (1975 -1982) as an assistant and tenured associate professor in the School of Medicine, University of North Carolina, Chapel Hill. Dr. Mitchell served for four years as a Clinical Assistant Professor at the Case Western University Medical School’s Department of Rheumatology. He also held a Clinical Assistant Professorship at the Ohio State University, School of Medicine, Department of Physical Medicine and Rehabilitation for 10 years. Dr. Mitchell currently serves as a visiting faculty to the University of North Carolina, Duke University Occupational Health Education and Resource Center.

As a researcher, Dr. Mitchell has been the Principle Investigator or Co-Principle Investigator on multi-year studies and demonstration projects dealing with Arthritis in the Work Place (PI); Disability Management and the Older Worker (PI); Vocational Adjustment of Individuals on Renal Dialysis or Transplant (Co-PI with the Cleveland Clinic Foundation); and the Development of Disability Management Model for Small Businesses (Co-PI).

Kenneth Mitchell was the Director of Vocational Rehabilitation for Highland View Hospital in Cleveland, Ohio during the early 1970’s. Dr. Mitchell served a two-year term (1982, 1983) as the Director of Rehabilitation for the Ohio Industrial Commission. From 1984 to 1993 Dr. Mitchell served as the President of the National Industrial Rehabilitation Corporation and as the Executive Director of the International Center for Industry, Labor and Rehabilitation, a private non-profit research and education group.

Dr. Mitchell has been an International Visiting Fellow for the World Rehabilitation Fund, completing a critical analysis of the Accident Compensation Commission of New Zealand. Other international activities include serving as an industrial rehabilitation education consultant to the Canadian Disability Institute, Toronto, Canada; the U.S. State Department’s Joint American-Yugoslavian Disability Project; the European Society of Cardiology, World Health Organization; and the Worker’s Compensation and Rehabilitation Commission of Western Australia.

Dr. Mitchell currently serves as Vice President, Return to Work Programs for Provident Companies, Chattanooga, TN. In this role, he provides program development services to large multidivisional employers as a stand-alone service or incorporated within a fully integrated disability insurance program.

Mitchell, K. "Principals of Vocational Rehabilitation: A Contemporary View:, Treatment and Rehabilitation of Ischemic Heart Disease. New York: Williams and Wilkins, 1980. Charles Long, M.D., Editor.

Mitchell, K. "The Aging Workforce and the Politics of Incapacity in the proceedings of the Eleventh Mary W. Switzer Seminar; The Aging Work Force: Implications for Rehabilitation. May, 1987.

Mitchell, K. "An Employer Based Disability Management Model:, In the Proceedings of the Statewide Conference - New Directions in Worker’s Compensation in Western Australia, July 14, 1988, Worker’s Compensation and Rehabilitation Commission, Perth, Western Australia.

Leclair, S.; Mitchell, K. "Work Disability - Corporate Assessment, Policy Development and Cost Reduction: A Resource Manual for Employers" International Center for Industry, Labor and Rehabilitation, Worthington, Ohio May 1988.

Mitchell, K.; Negotiated Disability, How to Prevent Light Duty as a Career Path. Provident Companies Training Monograph. Fall 1997.

Mitchell, K; Leclair, S. Building a Working Alliance with Employers; The Politics of Work Disability; Physical Medicine and Rehabilitation Clinics of North America Volume 3, Number 3, August 1992 pp.647 –663.

Mitchell, K.; Long, P., Lost Prevention and Disability Management - An Employer Resource Manual. Acordia McElroy Minister, Publishers, June 1996, 2nd Edition.

Mitchell, K.; Leclair,S. The Human Resource Managers’ Light Duty Survival Kit, Acordia, 1995, Columbus, Ohio.

Mitchell, K. Editor, The Medical Management of the Injured Worker. A Single Day CME program for Family Practice Physicians. A Cooperative Program with the Ohio State University, School of Medicine, Department of Family and Occupational Medicine, April 1997.


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