Strategies to Engage Infants & Toddlers Using Switches

1. Strategies to Engage Infants & Toddlers Using Switches Nancy Bolden, Assistive Technology Specialist North Central A.T. Access Site

2. ATK: MISSION • Increase awareness and knowledge of Assistive Technology (A.T.) devices and services for people of all ages and disabilities • Help people of all ages and disabilities acquire the devices they need for education, employment, living in their home, and participating in the community

4. DEVICE LOAN • ATK Device Loan System has an inventory of devices appropriate for infants, toddlers, and young children with disabilities Convaid Carrot – reclining car seat Zipzac I (possibly II also)

5. ATK Services • Acquisition of needed devices and services through: • Refurbishing donated, lightly used durable medical equipment to give to Kansans with disabilities and health conditions • Reviewing possible funding options (public and private), determining eligibility, and assembling needed funding justifications

6. KEE: Device Reuse • KEE is funded by KS Medicaid to provide refurbished lightly used DME • ATK accepts other lightly used devices for reuse although lacks refurbishing funds Otter Bath Chair Pediatric Commode Dreamer Stroller

7. How to Fund Assistive Technology • Acquisition of needed A.T. devices and services is the priority • Options vary depending on the device or service needed • Medicaid – EPSDT • Private insurance • Private funds/charitable supports • Part C funds • Part B funds (during transition) • Financial loan programs

8. Other Assistive Technology Services Call 800 – KAN DO IT (800-526-3648) to • request a device demonstration, • borrow a device, • get a refurbished device, • get help funding a device, • request product information, • learn how to use a device, or • request help in conducting an A.T. assessment

9. What is Assistive Technology? • Any item that helps a child actively participate in an activity or supports their ability to learn in their daily routines across natural environments. • IDEA 2004: • "any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of a child with a disability. Exception. - The term does not include a medical device that is surgically implanted, or the replacement of such device.” (§ 602(1)). • "any service that directly assists a child with a disability in the selection, acquisition, or use of an assistive technology device." (§ 602(2))

10. Types of Assistive Technology Devices • SELF HELP: weighted or curved spoons, dressing tools • HEARING: items that amplify sound, hearing aids, ear protection • MOTOR: built up grips on colors, dycem, switches, trays/slant boards • LEARNING: built in switch toys, e-books & apps, raised pages in a book Ear Bandit Adapted Book Crayon Rocks

11. Types of Assistive Technology Devices • MOBILITY: adapted strollers, walkers, ride-on toys, wheelchairs • POSITIONING: corner chairs, positioning harness, pillows • VISION: Magnifiers, color contrast/textured items Embrace seating system Boost magnifier

12. Types of Assistive Technology Devices • COMPUTER ACCESS: digital tablets, switches, adapted keyboards • ENVIRONMENTAL ACCESS: ramps, remote controls, van lifts • COMMUNICATION: picture boards, single message devices, electronic communication devices New Blue 2 for iPad Step by Step Communicator

13. HOW TO DETERMINE IF Assistive Technology IS NEEDED • A comprehensive assessment is typically an ongoing process that involves input from key people including the family, caregivers, • Request support from ATK on possible solutions • Examine daily routine – think least intrusive (environment, how child does it himself, how child partially participates – assist by peer, sibling, then adult) • Trial use of devices and evaluate its effectiveness • ATK Device Loan System • Local or national vendors

14. DOCUMENTING Assistive Technology ON THE IFSP • A.T. can be on a separate sheet of an IFSP or it can be embedded in existing components of the IFSP • Present level of development: child currently uses picture symbols to communicate words and phrases • Family priorities/concerns: parents want child to sit at dinner table with family (different chair? adapted seating system?) • Measurable outcomes: Child will read books before bed with his sister and participate by turning pages of cardboard books with page fluffers.

15. WHAT DOES Assistive Technology LOOK LIKE ON THE IFSP • Outcome examples across areas of development and learning will be provided • Implementation – quality standards • Frequency & length appear adequate for child and family’s needs • Outcomes need to be functional, specific, in family friendly language and reflecting their priorities

16. WHAT DO Assistive Technology SERVICES LOOK LIKE • A.T. is not the goal – how do we know it works? • Is it being used? • Is it still needed? • Is it helping child learn, be more independent? • What are the family’s concerns, comments?

17. EXAMPLES OF ASSISTIVE TECHNOLOGY • The appropriate A.T. solution is often the simplest one. • Rearrange the environment – move an activity to a table so the child can be seated and have better use of his hands • Material selection – use building blocks on a play mat with better color contrast so the child can see the individual blocks • Is more support is still needed? Try to find the one that lets the child participate independently. Peer and adult help is the next option.

18. LEGAL RIGHTS & RESPONSIBILITIES • A.T. must be provided in natural environments to meet a child’s needs (34CFR§ 303.13(a)(8)). • A.T. needs must be addressed during transition planning conference (34CFR §303.209(c)) and be included on the IEP. • A.T. services (assessment, recommendations, teaching use and maintenance) should be conducted by qualified professionals with active involvement by the family. • Family members have unique information about the child’s strengths and abilities, interests, daily routines, environments, and family priorities. • A.T. needs to meet the needs of child and family.

19. Why we teach switch use to young children with disabilities: To help a child understand that they are able to extend influence and control over their immediate environment As a foundation for future learning For children with severe physical disabilities, as a way to interact with the world (may be their only access method)

20. Assistive technology for young children: Evidence-based practice • Campbell, P., Milbourne, S., Dugan, L., & Wilcox, M. J (2006). A Review of Evidence on Practices for Teaching Young Children to Use Assistive Technology Devices, Topics in Early Childhood Special Education, 26(1), 3-13. • Reviewed articles about assistive technology published between 1980 and 2004 focusing on children birth through 6 years of age • The largest number of empirical articles were published more than 15 years ago • 12 studies focused on teaching switch activation use to young children with disabilities • Strong evidence that children younger than a year old with disabilities may be successfully taught to operate switches to activate toys

21. Assistive technology for young children: Evidence-based practice • Light, J. (1993). Teaching automatic linear scanning for computer access: A case study of a preschooler with severe physical and communication disabilities. Journal of Special Education Technology, 12, 125-134. • A single case study of an instructional protocol to teach automatic linear scanning for computer access to a child with severe communication and physical disabilities (cerebral palsy). The child was successful in learning to scan using the experimental protocol. • Several empirical studies have been published investigating the instruction of single and two-switch scanning in older children with physical disabilities.

22. How I Know My Child Can Use a Switch To Make Things Happen: I have identified a reliable, repeatable and consistent movement that my child uses to activate their switch I know what position works best for my child’s body and for their switch My child is pro-active and engaged in what is happening when the switch is activated

23. Resources for Beginning Switch Users The child’s physical and occupational therapists Switch Progression Road Map by Inclusive Technologies (free) www.inclusive.co.uk/articles/switch-progression-road-map Utilizing Switch Interfaces with Children who are Severely Physically Challenged (Goossens’ and Crain, 1992) Different kinds of switches and switch mounts available from Assistive Technology for Kansans equipment loan library (785-827-9383)

24. Different Ways to Use a Single Switch Press and hold (direct) Press and let go (timer) Press it again (switch building, sequencing) Turn things on and off (latched)

25. Switch Latch and Timerfor Battery Operated Items

26. Switches with Built In Latch and Timed Features

27. Powerlink Switch Interfacefor Electric Items

28. When Wires Are a Problem Ablenet Jelly Beamer Switch

29. Adding Speech Output toSwitch Activation Plug that extra little wire into the toy/appliance jack . . .

30. Strategies for Extending Single Switch Use After the Child Has Learned Cause/Effect: • Activate many things across the day • 60 Things to do with a Switch and a Battery Interrupter (Kate Ahern) • Ideas on How to Use the PowerLink at Home and at School (Northcott) • Use familiar adapted toys in new ways • 25 Things to Do with a Switch Activated Pouring Cup (Kate Ahern) • Fifty Fun Ideas for Simple Switch or Low Tech Activities (Molly Shannon) • Build opportunities into the curriculum • Ablenet Play and Learn preschool curriculum • Increase control of the environment • Electric toothbrushes, hair driers, personal fans, night lights and lamps, TV remotes

31. Using Two Switches • Start and Stop • One switch starts activity • Other switch stops • This or That • One switch activates one option • Second switch does something else

32. Using the Switch with a Computer

33. Wireless Computer Interfaces Super Switch IntelliSwitch QuizWorks

34. Using a Switch with the iPad There are switch interfaces for iDevices (Ablenet Blue2, RJ Cooper Bluetooth interface and more) At this time there is no full scanning and switch access option available that works with all Apps Scanning is available within individual Apps only Not all AAC apps will scan (Sounding Board, Predictable, TapSpeak Choice); more are coming Switch apps list from Helpkidzlearn.com, enablingdevices.com, janefarrall.com and others

35. How Scanning Works • One switch • Auto Scanning • Software/hardware determines speed • Two switch • Step Scanning • Child controls the speed

36. One Switch Scanning Positional Scan moves across row – left to right, top to bottom Each item is highlighted in sequence Child presses switch when desired item is highlighted

37. One Switch Scanning Popup • Child responds to on screen cue • Timing can be a challenge • May cause a startle

38. Two Switch Scanning • Move and Choose • 1 switch moves through options • 1 switch selects • http://www.bltt.org/switch/ani_tss.htm

39. Introducing Formal Scanning • Introducing the colored box to highlight on-screen choices • Use a “real” scan box • Choose a color that the child can easily see • Making choices with no wrong answer • The child chooses from 3 or more onscreen options • Whatever the child chooses, they receive the reward of activating that option

40. ChoosingIndependently • Nothing here • Choosing from a row with empty cells • “finding” activities • Finishing a sequence • Can involve empty or filled cells • Find the right one • Choose the answer to the questions or requests

41. Resources for Switch Activities on the Computer www.helpkidzlearn.com www.papunet.net www.northerngrid.org/index.php/component/content/article/81-sen/271-sen-switcher www.priorywoods.middlesbrough.sch.uk www.lburkhart.com/hand2sw4s.htm www.cricksoft.com www.rjcooper.com www.switchintime.com www.judylynn.com

42. HOW TO CONTACT US? • ASSISTIVE TECHNOLOGY FOR KANSANS • 1-800-KAN-DOIT • 1-800-526-3648 • OCCK, Inc., Solution Outreach Center • Nancy Bolden • 785-827-9393 • 1-800-526-3648