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Association of Tech Act Projects
In order to provide targeted information regarding major accomplishments and changes in states, evidence to support a continued federal role in technology provision, and continued barriers, the following is submitted. This is just a small sample of the successes achieved by state AT Act grant programs. More detailed information is available from NIDRR as it has the annual reports from all 56 grantees. The reader must keep in mind that changes have been slow and incremental. Some of these major accomplishments represent ends in and of themselves. However, most are milestones toward larger goals and have come at the expense of many years of advocacy and interagency coordination activities.
Marty Blair, Co Chair, ATAP
August 30, 2002
Major Accomplishments and Changes in States
- New England Assistive Technology (NEAT) Marketplace
In Connecticut, the recycling program is unique in combining recycling with a state of the art demonstration center, a computer lab, and extensive training programs. This comprehensive program is designed to become self-supporting. More information is available NEAT began as a pilot project in 1999 with funding from CIB/Oak Hill. In 2000, the CT Department of Social Services provided
start-up funding for the Equipment Restoration Center component of the project.Within just a few months, it became obvious how important the services we offered were to people with disabilities, their families and the individuals who work with them.We reached over 18,000 people during the pilot phase - in audiences, individually, over the phone and via the Internet.
- Leveraging of Additional Funds to Accomplish Program Goals
The following table is a sample of non-federal funds leveraged by state AT Act grant programs:
| State | Non-federal Funds (Purpose) |
|---|---|
| Arkansas | $1,667,794 (1995-present, for AT services, targeted training, and revolving loan fund)Ongoing amount varies. |
| Colorado | $1,394,000 (1999-present, for AT services and targeted training). $498,000 annual/ongoing. |
| Georgia | $227,000 (1997-present, for AT services). Ongoing amount varies. |
| Illinois | $440,000 (1997-present, for AT services). $160,000 annual/ongoing. |
| Kansas | $1,041,000 (1997-present, for AT services). $210,000
annual/ongoing. $650,000 (one time state appropriation for alternative financing program). |
| Kentucky | $2,006,900 (1998-present, for AT services and equipment recycling). Ongoing amount varies. |
| Missouri | $3,640,000 (1998-present, for AT services through DD council initiatives and early intervention). Ongoing amount varies. |
| Nebraska | $4,039,357 (1997-present, for home and community-based waiver service programs, job site assessments, purchase of AT). $1,100,000 annual/ongoing. |
| Pennsylvania |
$3,219,000 (1997-present, for state lending library). $890,000 annual/ongoing. $2,000,090 (1999-present, for VR grant program to small businesses). $1,000,000 annual/ongoing. $1,000,000 (1998-present, state appropriations for alternative financing program). |
| Utah |
$4,588,000 (1993-present, for AT services). $530,000 annual/ongoing. $75,000 (1993-present, private donations for alternative financing program). $85,000 (1997-present for AT training) |
- Access to Wireless Technology in the Pacific Rim
The Commonwealth of the Northern Mariana Islands (CNMI) AT Project proposed to Verizon, then GTE Pacifica, to havea text-messaging function in the cell phone to benefit individuals who have hearing and speech impairment. The text messaging was introduced in December 2000.
- Access to Library System
A partnership between Colorado Assistive Technology Partners (CATP) and the Denver Public Library system resulted in CATP's technical expertise being used to select, design, and place 12 accessible computers into 5 library branches. This collaboration has the potential to affect the lives of thousands of Coloradoans with disabilities by providing them equal access to library services, resources, and the Internet. This pilot project is a model for eventual statewide replication.
- Technology Loans for Employers
Assistive Technology of Ohio staff was very influential in developing legislation that passed through the Ohio General Assembly to implement a link deposit loan program for Ohio individuals and businesses. The first phase, called ACCESS OHIO, encourages Ohio's small business community to become more accessible to employees and customers with disabilities. The state's Treasurer's office makes available a portion of $10 million in short-term Ohio Treasury investment funds to offer the reduced-rate loans to eligible small businesses through a local lender. These funds can be used to make workplace modifications that facilitate the hiring or improve the accommodation for consumers with disabilities as well as assist Ohio businesses comply with the ADA. The second phase of the program offers reduced-rate loans to individuals with disabilities to help them purchase AT devices to enhance their quality of life and to help them seek employment. This proposed phase of the program would buy down the interest rate for AT devices, making them more affordable as well as obtainable for individuals in need of such devices.
- Implementation of Title III (Alternative Financing Programs)
A recent survey of state-based alternative financing programs funded under Title III of the AT Act of 1998 indicates that 15 of the 16 programs are administered by the state AT grantee program funded under Title I of the same Act. The state AT grant programs have developed a long history of expertise in the provision of assistive technology services and information to people with disabilities. They have broad experience with the consumer and technology needs targeted by the Title III loan programs.
The Virginia Assistive Technology System has provided extensive technical assistance support on loan financing program development. This support has led to the development of multiple loan programs throughout the United States. More than 18 states have recruited the services of VATS with in-person assistance that has resulted in improved program delivery and the expeditious delivery of loans and overall program development. In the past year, VATS co-sponsored the first national Micro-Loan Conference to promote loans for AT and microenterprise.
- Medicaid Reform
The Assistive Technology Partnership in Nebraska provides assessment for assistive technology and home modification alternatives to increase the availability of long-term care options for the elderly and persons with disabilities. The Partnership also authorizes Medicaid Waiver funds to complete the work as recommended. Similar initiatives exist in other states.
Texas recently passed legislation enabling people with disabilities to buy-in to Medicaid under the TWWIIA option. The Texas Technology Access Project provided active leadership of the coalition that spearheaded this bill. Not only are working Texans be able to access Medicaid AT-related benefits but they are also encouraged to save their earnings in special accounts in order to purchase AT they need related to employment. The concept of "buying-in" received enthusiastic legislative support and this legislation will likely serve as a model for future health care coverage expansions in the state.
In Illinois, the Omnibus Budget Implementation Bill, HB 4588, has provisions that authorize the Illinois Department of Public Aid to establish a Medicaid Buy-In program by administrative rule. The final budget includes $10 million for the program, an increase of $8 million over the Governor's original budget proposal. This Medicaid Buy-In program will enables working persons with disabilities to enroll or remain in Medicaid by paying co-payments or premiums once their income reaches a certain level. The Illinois project was a leader in this effort.
- Training of Assistive Technology Providers
Several states have developed rigorous training programs to certify professionals as assistive technology providers. This training provides critically needed skills and training to front line providers, practitioners, and consumers in the assessment, acquisition, financing, customization and maintenance of assistive technology. In Hawaii, for example, the number of certified Assistive Technology Providers rose from 1 to 16. In Utah, the increase was from 3 to 25. Certification training continues in these and many other states (e.g., Florida, Oregon, California).
The Nevada Assistive Technology Collaborative (NATC) worked to ensure the inclusion of AT and disability training in regular curricula for 76 different university courses over 9 different colleges. These curricula have increased students' knowledge of disability issues and understanding of AT applications and awareness of accommodation issues.
- Accessibility in Home Design and Visitability Standards
In Idaho, House Bill 611, the Statewide Accessibility Building Code was passed largely due to the efforts of the Idaho Assistive Technology Program. Before the passage of this bill, Idaho had no consistent statewide accessible standards for buildings covered under the ADA and the Fair Housing Standards. With the Idaho Task Force on the ADA and the Idaho State Independent Living Council, IATP organized an unprecedented grassroots coalition to undertake the task of developing consistent statewide accessibility standards for buildings covered under the ADA and Fair Housing Standards. IATP provided technical assistance during the development of the legislation and support toward passage during the 2000 legislative session.
In 1999, the Vermont Assistive Technology Program (VATP) initiated a "rental unit study bill" (S. 174) with the Vermont legislature to mandate minimal accessibility standards in all new 1-, 2-, and 3-family housing units built on speculation in the state. Known as the "Visitability" standard bill, VATP negotiated with the legislature to add language to the rental study that would include aspects of disability access. A 1999 interagency task force was established to work on this study. The agreements reached by this task force resulted in the passage of H. 612 on April 27, 2000. H. 612 mandates accessibility requirements for all new residential housing (including townhouses, condominiums, etc.) constructed in Vermont. Besides basic visitability features, the law directs VATP to work with the Department of Labor and Industry, Department of Housing and Community Affairs, and representatives from the homebuilding industry to create educational materials that explain the new construction standards and the advantages of "visitable" homes.
- Interagency Equipment Transfer
The Wyoming project (WYNOT) and Wyoming Protection and Advocacy agency designed an interagency equipment transfer agreement with the Department of Education. They developed a cooperative agreement among the pre-schools and schools to transfer AT equipment with the student as he/she enters grad school. An earlier agreement with the Dept of Voc Rehab had eased transition and equipment ownership for those students transitioning from school to work. This work is similar to initiatives in other states (e.g., Washington) that have developed similar interagency agreements.
Evidence for Continued Federal Support
The information in the previous and subsequent sections provides the best rationale for continued federal support. It is clear from the annual reports provided to NIDRR that the number of individuals affected by training and technical assistance activities continues to increase as do the number of individuals with disabilities and the emergence of new and more sophisticated technologies.
States have not and probably will not take over interagency coordination initiatives for cross-discipline, cross-age assistive technology service provision. States often develop interdisciplinary councils for information sharing and, sometimes, for dealing with complex, social service cases. They do not set up these councils to engage in the broad range of activities currently undertaken by state AT grant programs (e.g., policy monitoring, public awareness, technical assistance); these cross-disability, lifespan activities are not generally within the purview of state-funded agencies. Keeping pace with changing societal needs, policies, and rapidly advancing technology requires an intense, focused, interdisciplinary lifespan approach. Further, state service agencies focus their assistive technology-related training and technical assistance efforts on technology applications within their respective eligibility or entitlement domains. They do not address lifespan issues. State assistive technology programs are designed to address the broad range of disability issues across the lifespan.
In 1998, the National Institute on Disability and Rehabilitation Research (NIDRR) published findings and recommendations in the “Blueprint for the Millenium: An Analysis of Regional Hearings on Assistive Technology for People with Disabilities.” It described continued and emerging barriers to consumer acquisition of assistive technology. Proposed solutions to these barriers clearly indicated the need for the federal government to continue its support of the 1988 mandate. In response to the document, NIDRR invested nearly $1,000,000 to develop a national assistive technology data collection system. This data is to be used to monitor local, state, and national trends in AT use and acquisition, access to AT devices and services, and other consumer issues with regard to assistive technology. State assistive technology grant programs are the logical entity to address this new component of the federal mandate.
From data taken in 1999 and 2000, in average year the combined state AT projects provide:
Information dissemination – ranging from basic information to individualized responses – to an estimated 2,500,000 people.
Technical assistance and consultation – topics ranging from accessible mainstream technology to complex assistive technology issues – to an estimated 82,000 people with disabilities and 5,800 public and private agencies who in turn impact millions of people.
Training – including topics such as AT applications and selection, funding resources, IT accessibility, work site accommodations, and consumer empowerment – to an estimated 172,500 people.
Interagency coordination and policy development – including policies to maximize technology access within health and human services, education, early intervention, housing, employment, aging, and information technology to an estimated 3,200 agencies.
Remaining Barriers and Solutions
While much progress had been made in the areas of systems enhancement, public awareness and information, advocacy, training, and financing, tremendous advances in technology and public policy have outpaced state efforts to ensure access to, availability of, and funding for appropriate assistive technology. During the past decade, these advances have been met with initiatives to: (a) improve acquisition of new technology, (b) provide training in specific areas of need, (c) develop equipment loan programs and equipment recycling programs, and (d) improve access to accessible information technology in business and government. Emerging issues such as the Olmstead decision, the New Freedom Initiative, E-government initiatives, telecommuting, IDEA ’97 and its impending reauthorization, Section 508 final guidelines, personal computer use in homes, use of the Internet for personal and business purposes (E-commerce), the shift of public health care to managed care and PPOs, Ticket to Work: Work Incentives Improvement Act (TWIIA), election reform and electronic voting, accessibility provisions under the ADA, improved medical technology that prolongs the lives of people with severe disabilities, and the Telecommunications Act Sect. 255 were not anticipated when the sunset provisions were conceived. Technology-related initiatives and policies are evolving as rapidly as the technology itself.
People with disabilities want to work. They want to contribute to society, enjoy personal fulfillment, and earn a living. The nation needs workers and technology is the key to employment for persons with disabilities. Employers need assistance in identifying the technology solutions that will preserve or enhance their workforce. Disability and Business Technical Assistance Centers (DBTAC) have done an adequate job of assisting employers and employees understand the implications of the Americans with Disabilities Act. However, expertise on making reasonable accommodations and adaptations is rooted squarely in state AT Act projects. They often provide the technical assistance to DBTACs to enable them to achieve their goals. The State AT Projects provide links to services and devices that increase productivity and level the playing field for workers with disabilities.
People with medical problems need technology to improve or maintain their health and ward off secondary and/or progressive disabilities. But thousands of people with disabilities--both children and adults--are uninsured or have insurance coverage that limits access to medically necessary technology or professional assessment and therapy. Policy makers need an increased understanding of the medical necessity of assistive technology in improving and maintaining health.The State AT Projects with protection and advocacy programs recently assisted CMS (formerly HCFA) in changing its coverage policy for augmentative and alternative communication devices for adults.
Even when age or disability limits functioning, people want to be independent, mobile and productive. They want to be self-sufficient, live in homes of their own choosing and maintain control over their lives. To remain independent, technology becomes a critical tool for the aging population. However, many individuals and service providers are unaware of technology solutions and need help in identifying and using them. The State AT Projects provide extensive information and referral services as a part of their public awareness and outreach initiatives.
As the electronic age revolutionizes the way we access government, business, and the service industries, we must make sure that people with disabilities aren’t left on the outside looking in. There are many ways to give people the access they need, but awareness of why it is needed and how to do it lags far behind. Information technology personnel need assistance in understanding the impact of disability as it related to information technology access and how to comply with federal and state standards. The State AT Projects are called in to consult on multi-disability issues because of their experience with all forms of disability.
Unmet Needs
Education
Increasing emphasis on accountability and standardized testing correspondingly increases the need for understanding and use of AT to support valid student academic achievement. For many students with disabilities AT is the avenue to participate in standardized testing.
Increasing emphasis on early literacy can be supported and enhanced through the use of assistive and adaptive instructional technologies. Early communication using augmentative systems and computer adaptations such as alternative keyboards allow young children with disabilities to develop literacy at a pace in step with others.
Increasing demands on all teachers to have technology skills has created a parallel need for increased assistive technology knowledge for special and regular educators. If all students are to use educational technology effectively, adaptations and assistive technology must be available and used appropriately or students with disabilities will be left behind. There is a critical lack of professionals who are expert in assessing the assistive technology needs of students with disabilities, as required in constructing Individualized Education Programs (IEPs) under the Individuals with Disabilities Education Act (IDEA).
Employment
The Workforce Investment Act, Ticket to Work Act and other recent federal initiatives have created a state environment of change within the employment service system. One-stop employment centers are struggling to effectively service individuals with disabilities and are in need of extensive support and technical assistance to make their computer labs, telephones and other media accessible.
The increasing use of work related tele-commuting holds promise for increasing employment options for individuals with disabilities. Tele-commuting for people with disabilities frequently requires assistive technology in the form of computer and telephone adaptations. However, many employers and people with disabilities need assistance in obtaining the right adaptations and need support to ensure their successful use.
Health Care
Due to advances in health care increasing numbers of individual are living with permanent functional limitations, that require assistive technology for independence and productivity. Yet the health care system continues to classify most AT as durable medical equipment (DME) and health insurance provides inadequate or no DME benefits.
Information Technology and Telecommunications
Increasingly, Americans are becoming dependent on “on-line” information and services to accomplish everyday activities: booking travel, shopping, paying bills, checking a bank balance and accessing government services. For many people with disabilities that means having access to a computer AND the adaptation necessary to use the computer. Not only is this a significant cost barrier, it also requires access to support services to be able to select and use the adaptations which are difficult to come by. The movement to E-government at all levels of government increases access demands by people with disabilities.
Information technology and telecommunications products and services have become very complex and correspondingly the assistive technology in these fields has become complex. The greater the complexity, the greater the demand for individuals with expertise and the more scarce those people have become. People with expertise in mainstream IT and Telecom are difficult to come by for everyone these days; finding individuals with expertise in IT and Telecom accessibility for people with disabilities is even more challenging.
Public use information technology, particularly computer lab settings in libraries, colleges, and community centers, are typically not accessible for individuals who need computer adaptations. Unlike architectural access, there are no national standards or legal requirements for computer lab accessibility (e.g. at least one stations must have screen enlarging software) and as a result, many individuals are left unable to utilize critical public services independently.
Community Living
With impending passage of election reform legislation, states will be embarking on a major change in the type of voting equipment used. New equipment will need to be accessible for voters with disabilities and Secretaries of State and local election officials will need technical assistance in selecting accessible voting equipment and in training election officials in appropriate usage.
States continue to develop and refine their Olmstead plans to support the move of individuals with disabilities into community living. AT frequently plays a critical role is enabling an individual to live outside of an institutional setting.
Accessible housing continues to be limited or non-existent in many communities. A few states and communities have implemented “visitability” laws mandating specific universal design features be included in residential construction; but most of the country still has no incentive or requirement that will increase the number of accessible residences.
For most AT related to community living, such as home modifications and vehicle modifications, there is no core-funding source. This kind of AT is typically not funded by health care, education or employment – e.g. it is not considered medically necessary, educationally necessary, or necessary for employment. Yet without this basic AT, all other areas suffer. Funding is most frequently cobbled together though tenacious efforts to locate and secure community resources.
The aging of the American population is also increasing demand for AT for seniors. This population is typically unaware of AT options and requires extensive support in selecting and using AT because of limited prior experience with such devices. Access to AT can often be the reason why elderly people are able to stay in their homes rather than have to move to costly nursing homes.
Conclusion
States have done an excellent job meeting the mandates given in 1988 and renewed in 1994 and 1998. State assistive technology programs are in an excellent position, with the infrastructure in place, to meet the evolving mandates prescribed by current federal policy initiatives. With a very small federal investment the states can continue to leverage additional funds to address the technology initiatives of local, state, and national policy. The federal government has a role to ensure equal access and equal opportunity for all; no individual should be left behind. To eliminate state assistive technology programs when they are making strident efforts to address the needs of emerging federal policy and, more importantly, individual independence, is inconsistent with current federal initiatives. Losing the expertise and benefits of these projects would be very detrimental to national efforts to “increase access to, availability of, and funding for assistive technology through state efforts and national initiatives."