R6 Evaluation of Remote Computer Access Service Delivery
John Coltellaro,MS, ATP
Pennsylvania’s Office of Vocational Rehabilitation (OVR) provides vocational rehabilitation services to help persons with disabilities prepare for, obtain, or maintain employment. For many OVR clients, computer access is an integral part of their Individualized Plan for Employment. OVR clients seeking computer access are often faced with external deadlines (e.g., the start of a school semester or training program), which limit their opportunity for equipment trial periods. Obtaining training can also be problematic when a client leaves for a distant school. Computer access equipment is typically intended for long-term use, but there is limited support to update or reconfigure equipment as needs and abilities change.
An OVR client who receives computer access services at the CAT typically only visits the clinic twice, for an initial evaluation and then to pick up the ATD purchased for her or him. Sometimes, a clinician will deliver and install equipment in a client’s home or worksite, but OVR must reimburse the clinician’s travel time. Training sessions for the client will occur at the CAT. Once training is complete, the client receives little or no follow-up support from CAT. We propose a model of service delivery in which TR technology allows individuals to receive services remotely from the CAT to a client’s home or regional clinic.
Unlike previous research, we propose to use a large subject population and several consistent outcomes measures. In addition, prior work in this area has been qualitative, and focused on the utilization of low bandwidth POTS whereas we will apply a much more sophisticated synchronous and asynchronous TR infrastructure.
The objective of this study is to determine if individuals can obtain appropriate prescriptions for computer access technology through the use of a TR system. We will compare an entirely TR-based service delivery program, an entirely in-person program that mirrors current practice in most clinics, and a program that combines both in-person and TR-based interaction.
Each participant will be assigned to one of three groups:
- The Control group will receive all computer access services at the CAT.
- The Mixed group will receive the initial assessment at the CAT and all remaining services at a remote facility and/or their home through TR technology.
- The TR group will receive all computer access services through TR technology.
The assessment protocol for all groups will mirror that which is currently utilized in the CAT at UPMC and accepted by OVR. For members of the TR and Mixed groups, a local practitioner such as a vocational rehabilitation counselor or OT will be identified. The TR group will receive services with the following protocol. The Mixed group will have the initial assessment at CAT and then follow the remaining protocol outlined below.
- The client and local practitioner will be asked to fill out the intake form on the computer with assistance from the specialist practitioner.
- A physical and cognitive examination will be performed by the local practitioner with assistance and direction as needed by the specialist observing via TR.
- Client needs and goals related to computer access will be established.
- The client and local practitioner will configure and try computer access devices relevant to a client’s needs and goals while guided by the remote specialist.
- The team (including the client, et al.) will identify a solution that appears to be feasible for the client’s needs and goals via this interactive session.
- The specialist, in collaboration with the local practitioner, will prepare an equipment recommendation that will be submitted to OVR.
- Equipment will be delivered to the client with the local practitioner present and the remote specialist observing and directing as needed via a TR session.
- Subsequent TR sessions with the client and local practitioner will be conducted to provide training as authorized by the funding source. Training sessions will be saved for later use by stakeholders who cannot participate when sessions occur.
- The remote specialist can record additional video lessons for review by the client in between training sessions.
- In between training sessions, the client uses the web-based IDA system to determine whether the device’s configuration should be modified.
- After training is complete, the client uses the web-based IDA system every three months to determine whether the device’s configuration should be modified.
- After training is complete, the client can review archived lessons to learn about additional features of the equipment
Expected Findings and Deliverables:
We believe that service delivery mediated with TR technology will enable us to provide better computer access services and that such findings will promote the use of (and reimbursement for) TR services throughout the country. We will collect data from real-world use of computer access technology, along with several outcomes measures. This information will be useful to clinicians and researchers evaluating their own clinical outcomes. Dissemination will occur in conferences and peer-reviewed journals and by using TeleRehabNet.org. In addition, our results will be leveraged as preliminary data for larger scale studies of TR service delivery.
We have recruited 8 participants in the "standard care" group and 6 subjects in the "mixed care" group. We have purchased two laptops and several web cameras and speakerphones for the project. We have also purchased two Verizon wi-fi accounts. We have conducted several trial remote sessions to verify that Visyter will work with remote desktop sharing software and with computer access technology on a client's computer.
We've produced a series of videos on alternative computer access technology, which have been posted on iTunes U. Existing videos discuss keyboard-only computer access, switch access and pointing devices. Additional videos will be posted in the future, including videos on text entry and automatic speech recognition. These videos were produced with funding from the Paralyzed Veterans of America.
CRUMBS Computer Activity Monitor Software
CRUMBS records a participant's keyboard and mouse activity during use of their computer.
We have recruited four participants in the "standard care" group. We have purchased a laptop and several web cameras and speakerphones for the project. We have also purchased a Verizon wi-fi account and a WebEx on-line conferencing account. We have conducted several trial remote sessions to verify that Visyter and WebEx will work together and with computer access technology on a client's computer.
This project is not scheduled to begin until Year 2 of the award