2004 Conference Proceedings

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COMMUNITY RESEARCH FOR AT: CREATING BETTER EMPLOYMENT OPPORTUNITIES IN CALIFORNIA

Presenter(s)
Amy Noakes
CFILC
660 J Street, Ste. 270
Sacramento, CA 95814
Email: anoakes@cfilc.org

"The talking and Braille computers really contribute to my being able to do a job because I can store information, organize information and retrieve and research information from the "Net" by using talking and Braille computers. I also give presentations by using the Braille computer to read my Braille notes. By using those types of AT, I am able to manage information to successfully do a job."

Introduction

In the last few decades, technology has transformed virtually every aspect of our society. Particularly in the areas of communications, transportation and health care, technological advances have had a monumental effect on how we all live in today's world.

The effect of the advances in technology's on people with disabilities is no different. On a daily basis we witness new ways in which technological advances enable people with disabilities to more fully participate in all aspects of work and daily living by performing tasks previously considered as being beyond their capabilities. These advances in the lives of people with disabilities don't simply impact the individual's capabilities; they also reorder social perceptions of persons with disabilities. In addition to helping to create a new social view of persons with disabilities as capable and contributing members of society, these technological advances have also contributed to a positive change in the way in which individuals with disabilities view themselves and, indeed the entire disability community's cultural identity.

The California Foundation for Independent Living Centers (CFILC) has undertaken a broad research effort to look at the impact of technology and function in the areas of health, employment and independent living. In order to fully understand the system that surrounds the use of, and access to, Assistive Technology (AT) by persons with disabilities, CFILC researchers have elected to use a "Participatory Action" research design (Kemmis & McTaggart, 2000). By doing so, CFILC is uniquely able to investigate and report on both changes to the individual and changes to the environment. This represents a pioneering initiative, as it is one of the first times that a consumer-directed organization such as CFILC has received a major research grant from the National Institute on Disability and Rehabilitation Research (NIDRR).

The participatory action research methodology engages research participants in all phases of the research, from initial research design to the final presentation of its results. It uses a spiral, nested approach (Denzin & Lincoln, 1994), where new information suggests new actions, which, in turn, suggest more questions. The intent is to address both stakeholder needs and the issues of people with disabilities. Staff from the participating independent living centers and from CFILC was trained in these research methods and conducted the focus group portion of the project concentrating primarily on the use of Assistive Technology.

The Community Research for Assistive Technology (CR4AT) researchers had previously identified several major gaps related to the employment of persons with disabilities. These include:

To gather qualitative data, multiple focus groups, with a wide variety of populations were conducted throughout the state. 8 Independent Living centers held three to four focus groups. Meetings allowed for open submissions, either written or verbal, and required formal outreach to community organizations. Focus groups averaged around 10 participants, with a range from as few as two to as many as 16. A total of 333 individuals participated in focus groups. Although we made an effort to reach more people, the people we got represented those who were most interested and most able to come at the times that were set. The participants in each group shared at least one characteristic - either the use of AT, their type of disability, their employment status, their ethnic or racial status, or the type of AT service they used.

Specific questions CR4AT raised about employment included:

Answers in response to these questions ranged from simple to extremely complex. Our focus groups confirmed what we already knew: AT does improve employment outcomes for persons with disabilities. AT provides functional value, enhances productivity and increases physical and mental health. We also found there are many barriers to using AT in employment for persons with disabilities. Education of employers, co-workers, and the general public is needed to demystify disability and the use of Assistive Technology. In addition, funding sources for AT need to be streamlined and a standardized system adopted within funding agencies to aid those acquiring AT. Another major finding was the fact that AT does not need to be deemed "special", but rather if more products and devices were universally designed for a broader range of abilities then the AT system would be vastly improved.

What is Assistive Technology?

Before proceeding further, it is essential that a clear, concise and consistent definition of Assistive Technology (AT) be established. CR4AT defined AT based upon current Public Law as "any item, piece of equipment, or product, whether acquired commercially, off the shelf, modified, or customized, that is used to increase, maintain, or improve the functional capabilities of individuals with disabilities" (Technology-Related Assistance for Individuals with Disabilities Act of 1988).

According to the Americans with Disabilities Act (ADA) and other state legislation, employers are required to make changes and adjustments so that persons with disabilities can enjoy equal opportunities in all aspects of employment. These changes and adjustments are called "reasonable accommodations." These may include providing new devices or changing current equipment so that persons with disabilities can perform a job (Protection & Advocacy, 2000, p. 6-1).

When asked what types of AT are used for employment, the majority of the respondents revealed that a variety of devices are used. Adapted computer hardware and software, such as roller ball mice, flat screen monitors, large monitors, screen reader programs such as JAWS, and other adaptations were noted. Ergonomic office furniture, such as adjustable desks and keyboard trays, was common. Mobility aids such as wheelchairs, canes, or crutches was used by a variety of participants to enable them to be mobile both on the jobsite and off. Devices for the hearing impaired, such as amplified telephones were frequent. Conventional technology like personal digital assistants (PDAs), cellular phones and tape recorders also enabled those with disabilities to perform their job functions effectively. One respondent noted:

"I use my computer with different types of programs and I use a mouse, it is a little bit bigger than your average mouse. I have a reacher so that I can pick things up and grab things off of the floor if I need to or whatever I need to get to work, I depend on my power chair naturally, which goes in both directions whether it be work or something else and my vehicle is part of what I use to be able to get to where I need to go, since we do cover such a large area. I also use handless phones, to keep my hands free so that I can be doing my work and communicating at the same time."

Why is an ecological model needed for determining the importance of Assistive Technology?

As noted above, CR4AT employed the ecological model and a participatory action research design. The ecological model is a holistic research approach that "examines the complex challenges from every aspect and probes into the systemic issues at the societal, service and personal levels, and considers how the issues at these levels often intersect," (Status of Women, Canada, 2003). The selection of an ecological model to conduct community research implies that there is a need to investigate not only at an individual level, but to examine the environment and community in which the individual is embedded (Ferrari, 2000). The use of such an interactive systems model (Senge, 1999) is based on the notion that the community does not only influence individuals but that they also participate in its creation.

The ecological model is composed of three levels that interact synonymously - the individual level, the services / environmental level and the policy / systems level. Conducting analysis of the focus group data, the CR4AT project strived to look at all three levels to determine what was working and what does not work, and where changes can be made effectively.

At the individual or personal level, focus group results found that employment provided meaning and a sense of self-esteem to many respondents. Improved physical health, enhanced mental health and an increase in independent living skills and abilities were also identified as direct results of a person with a disability being employed with proper AT to aid them in performing their jobs. Functional ability and AT were closely related in terms of being able to do daily activities at work without assistance from others. This led to individuals feeling more independent and more capable of participating in the workforce, despite the beliefs of many that, "disability is synonymous with needing help and social support, reinforcing associations between disability and conditions of helplessness, incompetence, and the perpetual receipt of various forms of assistance" (Orange, 1997).

People's health was positively influenced by the use of technology in the workplace and through the provision of alternative work options by employers. For example, for employees who fatigue easily, employers provided additional breaks and other non-AT related accommodations. Job related tasks were made more comfortable and easier to accomplish by the use of AT, which in turn provided an increase in productivity in the workplace for both the employee and employer. When AT and reasonable accommodations are provided, tasks are completed on time and people with disabilities do not have to exert as much energy with the use of AT to complete the task than without the AT, which leads to better and improved health.

Key to being physically healthy is a requirement of good mental health. A healthy sense of self-esteem and an ability to consistently strive for better opportunities and increased independent living outcomes is gained from actively engaging in sustainable employment through the use of AT. There is a sense of inclusion in society through employment that breaks down the marginilization of persons with disabilities in the workforce, and society as a whole. With employment, a person with a disability is able to contribute to determining his or her own destiny and is able to live a better and more full life than the alternative - getting by on limited funds from government or private social programs.

According to one focus group participant:

"Well, I have a job I work for the county and I have been there for over two years and the way I see it right now is that I know I can do better than that but it takes time to build up your skills and to get the job you really want to get but to do that I have to build up my reading, writing and math and this is helping me to move to the next step ahead. I never thought that I would get this far in life, I have a lot more hope."

While AT has a major impact at the individual level by enhancing job performance and mental and physical health, the use of AT to access one's community and place of employment influences how a person with a disability accesses and interacts with their environment. On the service level, there is a call to examine the disabling environment rather than examining personal limitations - medical model or functional limitations - economic model (Orange, 1997). By creating accessible environments, people with disabilities can better become gainfully employed. Participants revealed the need for specific AT in employment settings. For many, the needed accommodations included universally designed changes to their office spaces, such as windows for natural lighting, relocation of cubicles, and creating a more centralized source for common resources used by everyone in the office.

One focus group participant said:

"If I had ample money, if money weren't an issue, I would find a location closer to public transit, I would centralize the supplies, and have all ergonomically designed equipment and furniture for everyone. I would try to address the needs of every employee, including those who aren't the normal A.T. user."

Employment is a vital component of every adult's life. For many with disabilities, seeking employment is too often experienced as yet another adversary encountered on the road to independent living. By looking outside the person's disability, and focusing more on altering the environment to accommodate one's needs, employment for persons with disabilities is not only possible, but it increases inclusion of the disability community into society.

On a societal level, systemic issues surrounding disability were uncovered. The use of universally designed products and services was recounted several times. Universal Design is "the design of products, and environments to be usable by all people to the greatest extent possible, without the need for adaptation or specialized design," (Center of Universal Design, 1997). Elevator buttons, bank machines, telephones and information kiosks all have the potential to be universally designed. Elevators that include instructions in Braille, visual floor displays and audio call outs of the floor and the direction the elevator is traveling is an incorporation of universal design, (CFILC, 2001.) "Another example is the use of volume amplification on telephones. This was originally designed for individuals who are hard of hearing, but it has proven to be very helpful to everyone using telephones in noisy environments such as an airport" (Alliance for Technology Access, 1999).

One respondent relays her experience with universally designed products that enhanced her job performance and improved her customer service skills on the job:

"Of course things like the phone help me, hands free phones are just a blessing to me and the other thing, we have devices and things around the store that I use; the little shopping baskets, if I'm assisting a customer for things they actually give me things to put in the basket to carry for them. Anyone else would just carry it up front for them, but with me I just put it in the little basket for them as I'm talking to them over by the men' s or cosmetic section and just walk them to the counter. I use a lot of things, but I improvise too, it really makes my job much easier and I feel really independent and I'm not depending on anybody. I'm giving them the customer service that I am sure they like, that I would want."

As more universal design principles, parameters and products are incorporated into legislation, the need for major redesign and architectural accommodations in the workplace will decrease, allowing more persons with disabilities to access and obtain employment opportunities.

How do people obtain AT?

We asked AT users how they obtained and paid for their equipment, how expensive it was, and what, if any, problems they encountered in securing funding. We found that devices were funded through a variety or sources. Some people paid for the devices themselves or were helped by their employers or the Department of Rehabilitation, while others relied on their health insurance provider to buy the AT needed in the home, which also aided at work.

For some of the focus group participants, they acquired their AT through self-advocacy. They knew what types of devices worked for them, and were able to define their needs. They conducted research with the help of the Internet and co-workers in order to locate the appropriate devices to aid them in their employment and education.

"I went to the wheelchair evaluator's and I pretty much knew what style I wanted and what I wanted on it, the equipment that I use at work was recommended to me by a coworker who helped me research equipment and pick things out."

Participants reported that they paid for much of the AT they used both at home and on the job themselves. Common or mainstream items such as computers, cell phones, and PDAs were the most commonly identified of these kinds of items. Prices ranged from under $50 up to $1600 for the devices they purchased out of pocket.

A small percentage of the participants had AT devices funded through their employers. 100 percent of these respondents had a positive experience with the employer paying for devices. Employers were found to be quite willing to purchase the devices people would need on the job. Some had exceptional experiences where the AT was bought for the employee before the employee even started work.

"Now the job that I have now; they got the assistive listening device before I even started the job, I just mentioned it and gave them a flyer on it and they went ahead and got it before I even got the job."

Health Maintenance Organizations (HMOs), Medi-Cal and other insurance agencies had purchased equipment that consumers used in getting to work, being mobile on the jobsite, and for activities of daily living. The most commonly used devices were wheelchairs and other mobility devices. Much of the equipment that a person needs is not only work related, but also used in the activities of daily living. Mobility aids, like wheelchairs are most commonly funded under the term Durable Medical Equipment (DME) from a large healthcare insurance plan, such as an HMO, PPO, Medicare or Medi-Cal, although these items sometimes have strict restrictions on use.

DME is defined as "medical equipment that is ordered by a doctor for use in the home. These items must be reusable, such as walkers, wheelchairs, or hospital beds" (Medicare.gov, 2003). For example, an item like a wheelchair must be for use only in the home to be funded through Medi-Cal. Say for example, someone has limited mobility and needs a scooter to get from his or her house to the bus to work. Often, health insurance will not cover the needed AT. However, if the scooter can be used in the home, then these agencies usually can cover it. Nevertheless, it must explicitly state in the request that the item is only for use in the home. Much to the chagrin of many people with disabilities, the needed devices that are covered under these healthcare plans often take months to years to receive. This wait further impacts one's ability to join the workforce with the AT necessary to conduct the activities of the job in an efficient and productive manner.

"The amount of my AT computer and mouse was I think $1400.00 in that area and as far as the process, it was like a three to four week process relatively easy to my employer, so that was the good part, but when dealing with other AT, it's rough, especially with Medi-Cal."

Department of Rehabilitation (DOR) was not commonly mentioned as a funding source for AT in employment. However, for those who did receive funding for AT through DOR, there were mixed experiences of both positive and negative. Some people easily received the services and devices they needed from DOR.

"I went to Department of Rehabilitation and they sent me to an access center to be evaluated and that is how I got my note taker and I also got a computer and now they are setting things up so that I can go to a computer class now that I have my own computer because I am about to start a new job."

For others, obtaining AT through the DOR was a difficult process. Due to the length of time it takes to receive AT for services, the DOR was not a successful funding source for many participants in the focus groups. Often this was seen with larger, costlier items such as wheelchairs and modified vehicles.

"There was a lot of time involved in the van and the power chair. When dealing with the HMOs or DOR, my [modified] van was a two-year process. I had to go through a lot of stuff to get to that point. When you have [to get] all of your equipment and safety features, those things tie you up for days and weeks it seems like. But I didn't have any hassles when it came to the employer paying for the [other] equipment. It's when I had to deal with the HMOs or the other types of programs that are out there, that's when it became difficult to me."

Funding AT is quite complicated and often involves great time delays. Participants had varied experiences getting their equipment funded. For some, it was a relatively quick process from getting the referral to receiving the device. Commonly, however, acquiring AT is a long and arduous process that can last months or even years. Many reasons given for not being able to get devices funded is the lack of funding sources, ineffective services from the funding sources, and the amount of time one has to invest in the process. It can be concluded that the smaller, less expensive items needed as accommodations do not seem to be a problem for persons with disabilities. It is the larger, more expensive AT devices that prove difficult in obtaining through the various funding agencies, such as DOR or Medi-Cal.

How does AT successfully impact employment?

We were happy to learn that many individuals lives have been enriched by having access to AT. Focus group participants were asked how equipment helped them access employment, including self-employment, and the difference that having AT has made in their work lives.

Due to having AT available to them, several individuals reported that they could become employed or become more employable than they had been without AT. Several respondents cited the use of AT allowed them to get to their worksite by using adapted private transportation or by using accessible public transportation. AT was reported to enhance effective communications on the job and computer aided technology aided many individuals in performing their job functions at the level that was expected.

"Without the technology, I don't think I would be employed today. It has allowed me to perform the essential functions of my job and keeps me informed on the AT that is out there. Before I worked here, I did not know the Quadjoy mouse existed and it has allowed me to again become a full-time employee."

For many participants in the focus groups, the functional value of using AT was closely related to productivity on the job. Persons are able to work longer at certain tasks with adapted equipment than they would without it. AT helps decrease pain and fatigue. Communications aided by AT also had an important functional value of the job. For those who are hearing impaired and wear hearing aids or need amplified telephones, they were able to receive those devices and work more efficiently and in some cases advance into upper management positions.

Mainstream devices such as cellular phones, personal digital assistants, and laptop computers are everyday devices that enable persons with disabilities to function and perform well in their current employment as well as obtain employment. These devices become vitally important and necessary for persons with disabilities. Because they are not considered "special equipment" many persons with disabilities have incorporated the use of these devices into their daily routines at minimal cost.

"It has allowed me to do everything I need to do as far as what's in my job description, having six counties to travel; if I didn't have my accessible vehicle I wouldn't be able to get to all of those locations, doing state wide and national activities; again the vehicle is tremendously important. The PDA helps me to keep all those different tasks organized and with my learning disability this is vitally important because I would be a scatter brain and not knowing what I need to do on each particular day. The cell phone allows me to be productive while on the road, I can still make and return phone calls, the computer allows me to do everything, I wouldn't have a job if I didn't have a computer. It allows me to communicate at the local level, state level, national, email and Internet access all those types of things; the technology allows me to produce more. By going from the pushchair to a power chair I am exerting less energy; the power chair allows me to be more productive,! I experience less fatigue."

The Internet and e-mail have created an equitable playing field for both those with and without disabilities. The introduction of the Internet has allowed people with disabilities to disclose their disability only when it becomes necessary. This in turn has created a major change in the way others view persons with disabilities, and how people with disabilities view themselves.

As one key informant stated,

"You add the introduction of the Internet and suddenly I am on equal ground with everyone else. Its interesting because another part of what I do is have to answer questions and talk to people by email, and input forms, what is interesting is I can actually introduce my disability when its relevant. But until I introduce it, I'm not seen as a disabled person. It's been interesting to watch the kind of effect because all my life I am used to people reacting to my disability first, and then me. Whereas, on the Internet, it's turned around and they get to know me first and then its relevant, I get to introduce my disability" (P. Hoye personal communication, July 8, 2003).

Still Striving for Success

Participants were also asked about the barriers they faced in employment using AT. An employer's perception of disability, the perception about the cost of reasonable accommodations, the lack of training on AT devices for the user, and problems with repairs and fitting were all problematic areas.

Negative employer perceptions of disability impact employability for people with disabilities. Discrimination by employers against persons with disabilities seemed to be a common occurrence in the job hiring process. Employers were not able to determine disability by looking at a resume. However, when the person with a disability was called in for an interview, the common experience with many respondents was that the employer was taken aback and unprepared or unwilling to hire a person with a disability. Consumers felt that the employer's negative perception of disability should be tackled through additional education and training for employers other than just a review of the laws surrounding employment for persons with disabilities, such as the ADA. But rather a better approach needs to be made at illuminating disability as something not to be feared. Moreover, persons with disabilities felt that not only do employers need to be educated regarding disability awareness and sen! sitivity, but coworkers as well.

"Sometimes we need to educate a company's fellow workers and not just the employers. Someone may need an extra break as an accommodation - people shouldn't tattle on someone who needs an extra break. There may be good reasons."

In addition to getting past the interview, persons with disabilities relayed that the reluctance on the part of employers to provide accommodations because employers were either misinformed about costs and did not understand that accommodations or alternatives could be made in a cost-effective manner for the company.

Professional training on their AT devices was a requirement expressed by many focus group participants. However, training proved problematic. The time investment to train on AT devices for employment was often long for both employees with disabilities and employers. In some instances, employees were provided with the equipment; but it was never properly calibrated to work with other devices. When no training is provided on the proper usage of AT devices, it negates the entire reasoning of having AT to aid in performing functions on the job.

"Yeah, I can type in messages and everything on it, I know how to use the Braille note, but we have never taken it to the printer and I don't know how to hook it to a printer."

"The Roller ball (mouse) helps eliminate stress on elbow; voice-activated software is goal for self, but is time-consuming to train system and to learn."

Moreover, many persons go without the needed AT in employment because they are afraid to ask their supervisors for accommodations. In several focus groups concerning employment, it was revealed that many people just simply did not ask for the devices they needed, and many lost their jobs because of it. Others asked for the accommodations, and were accused of complaining and asking for too much.

"But it's like you're afraid to complain and when I did my boss threw my paperwork at me. I asked to be transferred out of the unit. And then I ended up with a very nice boss. When you get discriminated against when something bad happens, it's hard to ask."

Transportation proved to be a problematic area for many when it came to employment. As was repeatedly stated, "one cannot be employable without the ability to get into work." Unfortunately public transportation is unreliable in many areas and being late or not showing up to work is not an option for many people and causes adverse effects on their employment status. According to one of our key informant interviews, "California is the culture of the automobile." Public transportation is limited at best in a city and nonexistent once you get outside of the greater city limits. While busses and other public transportation have made many strides in making their system accessible, service is still limited in suburban areas and almost nonexistent in rural areas, (Dr. M. Clark, personal communication, July 11, 2003).

"They understood the first time I was late, but if you do it too many times, you are screwed and they are going to try and work something out where I don 't loose a point, I'm at their [transportation service] mercy waiting to get picked up."

What happens when AT is not available?

We wanted to learn more about what happens when equipment is taken away or not available for use, either because it is broken, needs repair or is in the process of being replaced. By not having the proper accommodations, not only is work productivity negatively influenced in employment, but also health, and function are adversely affected. This issue arose most when consumers' AT had broken down and needed repair or replacement. Broken down equipment or equipment sent out for repair or replacement can place an undue burden on the person with a disability who relies on that equipment to perform well in their jobs every day. Outcomes include the inability to work at all while the equipment is unavailable, not being able to produce the quality of work that is set for an employee, and a decrease in functioning or an increase in pain. As one participant confided:

"I had trouble with a computer once on a job and I was off for three days."

When asked what would happen if the AT a person was out of order and unavailable for use, participants revealed a myriad of responses. All responses detailed that the person could "get by" without the AT if they "had to", however, respondents stated that daily functions would be more time consuming and difficult, and their employment options limited.

"I would survive I am always a survivor but I would have to go back to the cave men days of doing things. Back to manual wheelchairs, back to a vehicle that I will have to transfer my self from the vehicle, I would have to fold the chair up and put it into the vehicle. I think I would be able to find a job, but I am sure I would be under employed in that situation so it wouldn' t be a job to where I can make enough to support my family and myself."

For those participants who previously had equipment break down and it was not available for use at work, they felt a profound sense of loss and realized the extent to which they rely on their AT to perform well in employment.

"For me, I use PowerPoint to teach, and I found out just how much I needed it when the power point bulb went out. So it showed me how hard it was."

"I have been stuck at work all day with no batteries for my hearing aid and I can't function; when the battery goes your gone, your done."

Respondents felt that employers recognize the cost benefit of having employees with proper AT accommodations. In employment, when a device breaks down, it not only affects the functional aspects of the job performance, it also impacts the productivity of the employee who uses the device. When work does not get completed on time or in a consistent manner, not only are there problems for the employee, but also the employer. Suffice to say, situations like this can cause a performance issue for the employee and ultimately the loss of a job.

"Even if you have on the microphone I drop it [microphone] and that screws it up. When this happens, I don't get projects done in a timely manner and when my computer at the radio station wasn't working (while I was interning) I would try to go on the air and five minutes before going on the air the news director would be retyping my copy for me, which is not a good thing for him to have to do nor was it something they were impressed with me doing, nor was I ever hired there."

Strategies for a Successful AT System

We also asked people what they wanted to change. It was everything from individual to systems and policy change. Consumer education, employer education, and professional training were mentioned numerous times. In addition, participants in the focus groups wanted to see policy changes enacted that would create standard eligibility criteria from the funding sources, Universally Designed devices from manufacturers, and a large-scale, public education campaign about disability issues.

While AT has enabled many persons with disabilities to gain employment, there are still some areas for improvement when it comes to "matching" equipment appropriately. For some, it's about the ease of using the equipment, or having the equipment compatible with standard office equipment, such as a computer or telephone. Others would like to see AT that is more portable. Almost all of the participants would like to see an improvement in the services they receive for repairs and maintenance of the equipment as well as equipment that is functioning in a consistent manner.

"If I have a product that can increase my independence with the greatest ease while in use, being easy to plug in or unplug also portability, anything efficient and un-facilitated will make me happy, just "PLUG & PLAY" ."

Educating employers about both disability issues and AT was a frequent theme. The most common and relevant answers included:

We received a cross section of responses in regards to education on employment accommodations and employing persons with disabilities. In terms of public education, the respondents believed that disability needed to be demystified for the general public: non-disabled persons and employers.

"If I had a magic wand I would change societies attitude about hiring people with disabilities."

"I think education, period, just would enlighten us on things. I would like to take them and put them in a chair for half a day and tell them to deal."

Participants also felt that more assistance could be provided from agencies that promote employment for persons with disabilities, such as the Department of Rehabilitation. We received responses relaying that consumers felt that the Department of Rehabilitation could be conducting more education and outreach with local employers, letting them know and understand the benefits of hiring persons with disabilities and easing the their fears or concerns about the cost of accommodations. Consumers also wanted to see Department of Rehabilitation encourage employers to use the department's resources for hiring, a practice consumers thought wasn't occurring regularly.

"I think that this information should be available to the everyday employer, they need to be educated to hire people like us, I don't have a lot of experience and I don't feel like DOR, is trying to help me get any."

"AT really isn't as expensive as most employers think it is and even the simplest items can be considered AT that will enable someone to perform there job like it should be performed, its just an attitude change that we need."

Moreover, once disability is demystified, education on AT is also needed, from the concept of expensive and high-end, to something defined as useful for all, not only those with disabilities. In addition, AT needs to be looked upon as just another tool in the step to employment instead of "something special" (Dr. M. Clark, personal communication, July 11, 2003).

"A two-prong attack: tax incentives for employers and offer workshops in the industry and in the community to educate everyone. A.T. is not a scary thing. People don't understand what A.T. is. They think it's the high-end, super-duper computers, but more often than not, it's just down and dirty figuring out what is the cheapest way to achieve the task."

"I would probably look at universal design to try and educate employers so that they understand more and are able to access more as far as being able to see that type of productivity, it is important to me that they see that."

It is already well known that funding AT devices can be an arduous and time-consuming process. A consumer must know the "ins and outs" of a funding agency' requirements before getting the device approved, and then delivered for use. Because every agency who funds AT has its own set of eligibility requirements, including a list of devices that will and will not be funded, and an ingrained system that seems to work against the consumer, many people give up completely and exist with substandard devices, or none at all. The agencies that fund AT have "maintained eligibility criteria that are based upon the medical model definition of disability [in which] medical professionals must certify that an applicant has a disability. The eligibility criteria ignore the fact that environmental barriers frequently limit the full and equal participation of people with disabilities in employment and their community" (Council of Canadians with Disabilities, 2000). The deep-seeded medical model ! embedded in these agencies does not consider that persons with disabilities must leave their homes to participate actively in work and in their communities. "It does not engage in positive and meaningful ways with those who have disabilities, so that they are not socially ostracized and so become a barrier to their social participation" (Duchan, 2001).

A common suggestion that prevailed not only in Employment issues, but through all focus group topics was the need for a National System or Standard related to AT. The need for funding agencies and others to standardize the definition of AT exists. This definition needs to look at the practical uses of AT in a more broad fashion so that AT usage encompasses more than the medical model. Respondents felt that if change were to truly occur that it would need to begin at the higher levels of leadership, who then could set and implement policy.

"Change has to happen at the leadership level for it to trickle down, so I would look at the states, countries and counties to change their attitudes on hiring people with disabilities, when they change, the attitude will trickle down and change people's opinions on people with disabilities."

Because the funding agencies follow the ingrained philosophy of the medical model, the time it takes to gets devices funded can be incredibly long and grueling. The suggestion was made consistently to streamline the funding process by making the forms available in various agencies and online, as well as cutting down the time it takes to receive an answer regarding the funding of devices.

"I would like to see when you apply for devices to have a shorter turn around time, instead of waiting 60 days for them to tell you that they don't know if you can get the device or not, then you have to wait another 30 days to find out what they decide to do, then it takes another 30 days for the process to go through, it is such a long process and they keep saying we have so many of you, I know a lot of people who have gone through that."

As part of funding, there also needs to be opportunity to "try before you buy" to make sure such equipment is appropriate. Most of the time, consumers buy equipment, and it doesn't fit the consumer's needs. Because people didn' t shop well enough, look well enough, or were not able to try it out, they end up getting less than the optimal device. If they can try out the device first you can ensure it is functional and matches with the individual (Dr. M. Clark, personal communication, July 11, 2003).

As much of the technology that was originally intended as AT is becoming more and more mainstreamed for non-disabled users, there is a wider acceptance of these devices. However, devices intended solely for those with disabilities still carry a stigma that non-disabled persons have a hard time accepting and using.

"The technology that was most beneficial was what the hearing people were willing to accept. They gave me a TTY when I'd been there for 9 years. 9 years later two people in the school district had called me on the phone in all that time, because they refused to use the Relay. Email came in at the same time and ALL of my communication became email, and that saved my job. Because the TTY was a deaf device and email was not."

Conclusions

Focus groups provide a value in research that cannot be found with surveys and collecting quantitative data. Focus groups allow us to see trends that occur, as well as quality issues that have not yet been addressed.

Consumers in the CR4AT focus groups spoke to the quality of life - health, energy, and participation - that AT has provided for them. I think you can say the same about "AT" for non disabled folks: microwaves, washers/dryers, cell phones, navigational systems (for those of us who are chronically lost), PDAs all help "non-disabled" as well as disabled. All of us are better able to function as a result of these helper technologies. One conclusion is that we need to stop looking at Assistive Technology as special and people who need it as special. Just like a microwave or a dishwasher is now pretty standard for most people (not all but they are cheap enough to be in reach of many people), hearing aids, wheelchairs and Braille-n-Speaks should become standard for people with disabilities.

It was evident that employer's who provide their employees with the needed AT improved the employee's ability to be productive as well as increased their self-esteem. Those employers who did not provide AT had a direct impact on the employee's self esteem and hindered productivity.

There is a near universal experience of frustration encountered when dealing with third party payers for AT. The difficulty of third party payers funding AT as opposed to employers paying needs highlighting. A call to action needs to be formed to change the definition of Assistive Technology to encompass more items that impact a person's ability to live independently. A consumer model needs to be adopted in al funding agencies. Specific solutions to this problem include: a national system / standardization of AT; definition of AT changed to encompass a more holistic approach to living with a disability; centers that allow a person to try AT before it is purchased, thereby reducing the waste of millions of dollars on inappropriate AT; streamlining the funding process through the funding agencies by making the forms more accessible, keeping information on file, and lastly AT service providers and vendors accepting and accruing accountability for their services.

Evident throughout the course of this paper is the fact that many of these findings are already known within the disability community, and they have been known for a very long time. So, the next question in the research cycle becomes, "Why has nothing changed if we know what the problems are and have solutions to these identified barriers for persons with disabilities?"

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