The mission of TnT is threefold:

2. Mission The mission of TnT is threefold: (1) to study prevalence, policy and resources, individualized decision making, training and support and other factors related to use of assistive technology (AT) devices and services in early intervention. (2) to disseminate current knowledge and research findings in timely ways to families, multidiscipline EI providers, administrators, educators ad policymakers using a variety of methods and approaches. (3) to partner with parents of children with disabilities, with individuals with disabilities, in the design and implementation of the national research program.

3. Federal & State Policy • Child & Family Outcomes • Families are able to support their children’s development in natural contexts • Children are able to participate in activities that promote growth and learning in natural contexts • Children’s growth and learning opportunities are maximized Community & Financial Resources AT Use & Practices Families & Children Early Intervention Service Providers Conceptual Model for Understanding AT Use, Practices, and Early Intervention Outcomes

4. Institute Research Questions • Understanding AT use & prevalence • Policy and resources for AT in EI • Understanding & improving decision making, assessment, & typical practices • Identifying & implementing effective training & resources for system change • Identifying & understanding funding resources

5. Studies

6. Studies • Policy Studies • Part C Survey (n = 42 Part C Coordinators) • Tech Act Directors Interview (n = 46 State Tech Act Directors) • State Document Analysis (n= 28 states) • Profile of State Characteristics & Training Summary (n = 51) • Lending Library Survey (n = 39) • Indicator Instrument (in process) • Parents • National Parent Phone Survey (n = 924 parents of children under 3 years of age; 845 whose children had used AT)*** • National Parent Web-Based Survey (n = 569) • Practitioners: • National EI Practitioner Phone Survey (n = 967)*** • National Follow-Up Survey (n = 450 who participated in the initial study*** • National EI Practitioner Web-Based Survey (n = 616)

7. Studies • Evidence-Based Practices review (115 articles from 1980-2003; 38 contained empirical evidence about practices)*** • Providers self efficacy about AT for infants and toddlers (n=86)*** • State Implementation Study N= 22 states (- Miss) N = 26 sites (– Miss) N= 91 interdisciplinary service providers N= 234 parents N= 234 infants and toddlers

8. Understanding AT Use & Prevalence

9. 4% of infants/toddlers nationally have AT listed on their IFSP’s (DOE Report to Congress, 2004) & this number shown little change over the years. • Approximately 4% of infants & toddlers in the NEILS sample were reported to be receiving AT services • 18.1% of providers sampled believed that all children on their caseloads who needed AT were receiving it; 15.7% reported that none of the children who needed AT were receiving it.

10. Infants & Toddlers with AT on Their IFSP

11. (Part C Coordinators)

12. (Part C Coordinators)

13. What Do These National Data Tell Us? • AT is not likely to be listed as a service or device on the IFSP’s of infants and toddlers. • Use, as recorded on the IFSP under the AT category has remained stable. However, this still doesn’t provide us with information about the extent of underutilization. • There is wide variability in definitions of AT devices across the states

14. Understanding AT Policy & Resources

16. Policy regarding… State Local State and Local Not Covered Payment for AT devices and services 66.7% 2.4% 16.7% 11.9% Ownership 43.6% 2.4% 12.8% 33.3% Eligibility for and access to AT services 73.8% 2.4% 9.5% 14.3% Relationship of AT devices to AT services 44.7% 5.3% 10.5% 36.8% Documentation requirements 66.7% 5.1% 15.4% 10.3% Maintenance and repair 30.8% 7.7% 10.3% 48.7% Recycling 18.4% 7.9% 13.2% 47.9% Requirements for transition to preschool 25% 5% 10% 57.5%

17. Availability of AT ResourcesPart C Coordinators

19. Availability of AT Resources • Providers -- • 23.6% reported a lot of AT resources in their communities; 27.6% reported only a few or no resources • 49.6% reported access to loan library • Parents -- • 34.1% reported access to loan library (23.8% did not know if library existed) • Tech Act Directors -- • 60.7% reported either state-wide or regional lending libraries available for infants & toddlers • Lending Library Directors -- • 28 (72%) report making < 25% of all loans to infants and toddlers

20. Identifying & implementing effective training & resources for system change

22. Type of Training Program/ Intended Audience Reported by Tech Act Directors In- service EI Providers EIs/ Families Pre-service Service Providers EI Related Service Providers Families

23. Sponsors of the Training Programs

24. State Level Collaboration

25. How well does your state AT project work with the state’s Part C system?

26. Identifying & understanding funding resources

28. Understanding & improving decision making, assessment, & typical practices

29. Overview of Surveys • Practitioner Questionnaire and Follow-up Practitioner Questionnaire • State Coordinator and Deaf-Blind Program Coordinators Survey • 2nd Provider Follow-Up Study

30. Overview of Surveys and Samples Practitioner Survey 1 • National Sample of 967 multi-discipline professionals who worked with a minimum of 3 children per week • 23-item questionnaire conducted through phone interview • Provider demographic information • Perceptions and definitions of AT • Prevalence and use of AT • Influences on AT decision-making process

31. Overview of Surveys and Samples Practitioner Follow-up Survey • A follow-up survey including 424 of the multi-discipline professionals who participated in 1st survey and agreed to be re-contacted. • 43-item questionnaire conducted through phone interview • Provider demographic information • Training and education experience in AT • Decision-making: “What would you do?”

32. Overview of Surveys and Samples Deaf-Blind Program Coordinator Survey • 36 state directors/coordinators for programs for children who are deaf-blind • Representing 30 different states + Puerto Rico • 30-item questionnaire: A combination of practitioner surveys 1 and follow-up • Demographic information • Perceptions and definitions of AT • Decision-making: “What would you do?”

33. Overview of Surveys and Samples State Coordinators • Same survey as the practitioner follow-up survey • Provider demographic information • Training and education experience in AT • Decision-making: “What would you do?” • 31 providers representing 21 different states • Nearly all female (1 male) • Disciplines: OT, PT, SLP, CDS, Early childhood education, AT specialist, Special Education, Social work, Education, Service coordinator, Family support studies.

34. Under What Conditions Are Providers Most Likely to Recommend AT?

35. Provider Decision-Making

36. Decision-Making • Providers’ reported decision-making about when to use AT generally reflects current views about best practices for infants and toddlers who may need AT • Families and providers beliefs about AT are concordant with one exception – prerequisite skills for AT. This likely reflects a gap between parent and provider decision making processes • Policy and procedures were not a strong factor that providers would consider in their decision making processes

37. Providers: Decision-making What would you do?….. • Playing with toys • Dressing • Crawling and Walking • Bathing • Vocalizing • Eating and Drinking

38. Case Example 1: Child can hold but not manipulate toys

39. Case Example 2: Child is unable to participate in dressing

40. Case Example 3: Child can not get around by crawling or walking

41. Case Example 4: Child unable to sit up for bathing

42. Case Example 5: Child is struggling not talking and struggling to vocalize

43. Case Example 6: Child can not eat or drink without assistance

44. Training

45. Overview of Surveys and Samples 2nd Provider Follow-Up Study 616 providers 45 states 21 Item web-based survey Demographics Activity and Routine Situations

47. Primary Setting where Services are Provided