Psicologia del funzionamento e della disabilità

1. Psicologia del funzionamento e della disabilità 4. La valutazione delle tecnologie assistive Prof. Stefano Federici – A.A. 2012-2013

3. Segment 1: Factor 1 Modeling the ATA process Segmento 1: Fattore 1 Modellizzare l’ATA process

5. 5 pillars of the ATA process model ATA PROCESS

6. Phase 1: Theuser seeks a solution Phase 1: User data collection The Assistive Technology Assessment process Phase 2: Evaluation data Phase 2: Theuser checks the solution Phase 3: Matching process Phase 3: Theuser adopts the solution Phase 4: Assistive Technology Provision and Follow-up of the assistive solution in context

7. The ATA process under the lens of the ICF biopsychosocial model Health condition (disorder or disease) Body Functions and Structures Activities Participation Assistive Solution Medical diagnoses* User driven process ** Support & follow up *** ICF – biopsychosocial model MPT Well-being Environmental Factors Personal Factors

8. Limiti e vantaggi di un modello ideale di ATA process Limiti  • La difficoltà di definire un unico AT system delivery • La straordinaria varietà di sistemi sanitari influenza in differenti modi le specifiche caratteristiche che delineano ogni singolo Centro. • La comunità scientifica sta perseguendo un AT system delivery che sia sempre piùindividualizzato. Come si usa dire Centratosullapersona. Vantaggi • Emerge come una sintesi di esperienze di modelli regionali. • Si condivide un modello teorico e criteri di valutazione. • Permette di condividere dati essenziali alla ricerca scientifica. • Aiuta a pianificare e valutare politiche nazionali e internazionali. • Può aiutare a valutare la qualità dei servizi.

9. Summarizing the 3 main elements identified in SEGMENT 1

10. Question time – SEGMENT 1 • If the goal of the ATA process is to model an effective assessment process for providing an assistive solution, why does (in the phase 4 of the ATA process) the Center provides an “Assistive Technology” and not an Assistive Solution? • Because in the phase 4 we are referring to the provision of an assistive device, evaluated as needed to reach an assistive solution. • The assistive solution is the entire process and the outcome.

11. Segment 2: Factor 2  Managing the ata process: the psychotechnologist Segmento 2: FaTtore 2  dirigere l’ata process: lo psicotecnologo

12. Tra l’utente e la tecnologia: Lo psicotecnologo Caratteristiche della tecnologia Bisogni dell’utente psicologo tecnologo

13. What the Psychotechnologist is and is not • Cognitive ergonomist • Evaluates the interaction according to a dualistic reciprocity between two poles: the user system and the artifact system (Norman 1983). • Psychologist(in Center for AT provision) is an expert in • personal factors; • human relationships and communication; • psychological assessment and intervention; • dynamic biopsychosocial variables. • Why not? • Psychotechnologist is not a clinic/dynamic psychologist. • Psychotechnologist has a background in (rehabilitation) psychology. • Why not? • Psychotechnologist evaluates the interaction according to a user-AT-milieu holistic model. • Psychotechnologist is an expert of assistive solutions.

14. Cosa fa lo psicotecnologo • Strumenti: • ATD-PA • QUEST, • SUMI, • IPDA… Sistema Tecnologico Barriere e facilitatori Sistema-utente Sistema socio-ambientale Prospettiva biopsicosociale

15. University courses Assistec – Austria(Miesenberger, 2006) • Corso e-learning; • 4 moduli e 17 seminari; • Diploma in Esperto in Tecnologie Assistive. Modulo 1: Fondamenti Modulo 2: Conoscenze specifiche sulle Tecnologie Assistive Modulo 3: Processi di Assortimento e Fornitura di TA e ICT Modulo 4: Tecnologie Assistive in Pratica e Applicazioni

16. University course Master in Psicotecnologie per Soluzioni Assistive • Corso universitario; • 4 moduli, 1000 hdi insegnamento frontale, 500 h tirocinio and workshop; • Diploma in Esperto in psicotecnologie. Modulo 1: Fondamenti Modulo 2: Introduzione alla Psicotecnologia Modulo 3: Elementi di base e avanzati su Tecnologie Assistive Modulo 4: Soluzioni Assistive

17. Summarizing the 3 main elements identified in SEGMENT 2

18. Question time – SEGMENT 2 • Does a psychotechnologist have something to do with the method of psychotechnology in the applied psychology proposed by Igor Smirnov to manipulate human mind by means of technology? • No, it doesn't! Not at all. As we previously explained, the psychotechnologist does not have anything to do with thought control! • In fact, the current concept of psychotechnology is related to a neologism to explain a new professional figure which investigates the psychological and cognitive components involved in the interaction environment, be it either a physical environment or a Information and Communication Technology one.

19. Segment 3: assessing personal factors in a center for technical aid

20. The Number OneSuspect in AT abandonment: Personal factors • Philips & Zhao (1993) Predictors of Assistive Technology Abandonment • Scherer et al (2005) Predictors of assistive technology use • Dijcks et al (2006) Non-use of assistive technology • Lauer et al(2006) Factors in Assistive Technology Device Abandonment • Verza et al (2006) Evaluating the need for assistive technology reduces equipment abandonment • Federici & Borsci (2011) The use and non-use of assistive technology

21. Health condition (disorder or disease) What the personal factors are Body Functions and Structures Activities Participation ICF - biopsychososcial model Environmental Factors Personal Factors

22. Why the AT Service provision is an expensive process The variability is an obstacle because it is a cost

23. Return on Investment (ROI) in assessing personal factor Matching Aid and Person, financed by the Italian Umbria Region in 2009  Identify the percentage of AT non-use and the users’ satisfaction of AT in a national health system. • Federici, S., & Borsci, S. (2011). The use and non-use of assistive technology in Italy: A pilot study. In G. J. Gelderblom, M. Soede, L. Adriaens & K. Miesenberger (Eds.), Everyday Technology for Independence and Care: AAATE 2011 (Vol. 29, pp. 979-986). Results • Mean of non-use 18%(good!) • Main reason of AT non-use  Personal Factors ROI on personal factors in Umbria Region = $ 2,000,000 Umbra Region Aid and Prosthetic Service Provision Economic waste 2007-09 Economic waste 2009 Umbria population = 908,000

24. How to invest in personal factors Macro-level • WHO Develop personal factor categories within the ICF Local-level • Employ psychologist as expert in personal factors • Meloni, F., Federici, S., Stella, A., Mazzeschi, C., Cordella, B., Greco, F., et al. (2012). The Psychologist. In S. Federici & M. J. Scherer (Eds.), Assistive Technology Assessment Handbook (pp. 149-177). Boca Raton, FL, US: CRC Press. Psychologist in a AT service delivery process provides an appropriate psychological evaluation or a precise clinical intervention with the user/client and/or their significant human context over the course of the whole AT assignment process.

25. What the psychologist does • Identifythe user’s personal factors, priorities, preferences, etc.; • advocatethe user’s request; • act as mediator between users seeking solutions and the multidisciplinary team; • act as team facilitatoramong members of the multidisciplinary team; • reframethe relationship between the client and his or her family.

26. Psychologist’s role User Actions Center for Technical Aid TEAM TEAM START User/client REQUEST FACILITATE The role of the psychologist in the ATA process Contact Request to solve activity limitations Request to solve environmental restrictions FACILITATE User data collection IDENTIFY Providing history (medical, rehabilitation, support use) and psycho-socio-environmental data Multidisciplinaryteam meeting for: - user data valuation and - setting design NOT ADVOCATE Identify  Advocate  Mediate  Facilitate  Reframe  User subjective evaluation of technological aids Setting set-up Matching process:- assistive solution proposal- assistive solution user-trial- assistive solution outcome MEDIATE User evaluation of assistive solution Assistive solution Multidisciplinaryteam evaluation NOT NOT NOT Assistive Technology obtained:public health system or public/private insurance User agreement NOT Short/Long-term use • Effectiveness • Efficiency • Usability • Personal, emotional, social, comfort with use • Subjective well-being -Benefit Assistive Technology Provision REFRAME User Support Follow up

27. Summarizing the 3 main elements identified in SEGMENT 3

28. Question time – SEGMENT 3 • Why is the engineer not an expert in personal factors? • The engineering curriculum does not typically include this. • Because knowing about personal factors is not equivalent to knowing subjective dimensions and individual functioning. • Theoretical acknowledge of personal factors does not reveal the psychological and existential side of the individual’s functioning.

29. Segment 4: assessing environmental factors in a center for technical aid

30. Why assess the environment

31. Health condition (disorder or disease) What the environment is in the ATA process Body Functions and Structures Activities Participation Definition ICF Contextual Factors ICF - biopsychosocial model Environmental Factors Personal Factors Environmental Factors Personal Factors Dimensions

32. How to assess environment ICF Constructs Output User’s Performance

33. How to improve the user’s performance  AT facilitator Measures of Environment and AT impact Mirza, Gosset, & Borsci 2012 Decisions for Improving User’s Performance • Modify Environment • Modify AT • Modify AT and Environment

34. Assess the match between AT and environment • Accessibility Ideal fit • Universal • Design • Sustainability

35. Assess the match between AT and environment

36. How to assess accessibility

37. How to assess Universal Design

38. How to assess sustainability

39. Center for Technical Aid Environmental Assessment Process Check the match Environment data collecting START Environment Contact Universal design Accessibility Sustainability AT/end user User data collection MATCH ENDEXIT TO Multidisciplinaryteam meeting for: - user data valuation and - setting design YES NOT NOT Check the impact Modify the environment in use (Mod–Env) Proposal of a new matching process or strong personalization (Prop–nMP) IF IF Setting set-up Matching process:- assistive solution proposal- assistive solution user-trial- assistive solution outcome Impact of environment modification Impact of a new matching process Climate Impact Assistive solution Multidisciplinary team evaluation Mod–Env Results Prop–nMP Results NOT Take a decision MATCH Mod–Env<Prop–nMT Prop–nMP < Mod–Env IF IF EXIT User agreement IF NOT Prop–nMP =Mod–Env NOT Assistive Technology Provision Results Change the AT ENDEXIT TO User Support Change both Change the environment Change the AT Change AT and environment Change Environment Follow up

40. Summarizing the 3 main elements identified in SEGMENT 4

41. Question time – SEGMENT 4 • Must we restart the Environment Assessment process when the result of the process suggests a need to modify or completely change the AT? • Yes, you should. All the steps of the Environment Assessment decision-making process might need to be repeated when a modified or a completely new AT is proposed by the multidisciplinary team.