Pennsylvania’s Assistive Technology Lending Library

Report on Progress: July 1, 2015 – June 30, 2016

Overview and Challenges

The Institute on Disabilities, Pennsylvania’s University Center of Excellence in Developmental Disabilities at Temple University, has completed another successful year of operating Pennsylvania’s Assistive Technology Lending Library (ATLL), under the auspices of the Department of Labor and Industry, Office of Vocational Rehabilitation (OVR). In this capacity, the Institute on Disabilities has built on the infrastructure and accomplishments of Pennsylvania’s Initiative on Assistive Technology (PIAT), a federally-funded program of the Institute and the Commonwealth’s program authorized by the Assistive Technology Act of 1998 as amended (the “AT Act”). As state funds shrink, assistive technology (AT) device lending activities are increasingly supplemented with federal funds through PIAT.

Pennsylvania’s Assistive Technology Lending Library is designed to provide Pennsylvanians with disabilities, older Pennsylvanians, and those who support them with the opportunity to learn about and try assistive technology devices “before you buy” – so they can make an informed decision. The success of this program can be measured by the number of requests to borrow, the number of devices circulated, the number of borrowers who are served (including the number of new and the number of unique borrowers), consumers’ satisfaction with the program, and the outcome of device loans (e.g. decisions to purchase – or not purchase – specific assistive technology devices). Consumers also borrow devices while they wait for funding or while their device is “in the shop”; devices may also be borrowed as a temporary accommodation. Devices may be borrowed by other stakeholders to promote awareness of the range, scope, and potential of assistive technology or to train providers about the variety, benefit, and applications of AT.

The Institute on Disabilities implements its Interagency Agreement with the Pennsylvania Department of Labor and Industry, Office of Vocational Rehabilitation guided by the principles of consumer-responsiveness (e.g. through exemplary customer service) and consumer direction (e.g. increasing the informed involvement of persons with disabilities in the process of selecting their own assistive technology).

State funds for Pennsylvania's Assistive Technology Lending Library support a centralized program designed to assure equal access to all Pennsylvanians with disabilities by providing points of entry and information throughout the Commonwealth, overcoming the barrier of transportation by using a “drop-ship” model of delivering and returning the equipment at no cost to the borrower, and maintaining an inventory of devices which are useful to individuals with physical, sensory, and/or intellectual disabilities. In addition, items in the inventory are useful to infants and toddlers, young children, students (including post-secondary students), adults, and/or older Pennsylvanians, and may be used in a variety of settings (home, community, school, or work). The needs of the constituents of the original five supporting Departments—Aging, Education, Labor and Industry, Health, and Public Welfare—are considered and balanced against available resources as decisions are made in the implementation of the program.

Considering thedecrease in appropriations over the last several years and the administrative fee levied by OVR, the Lending Library operates on a budget more than 60% lower than that in 07-08. State funds for the Lending Library buy fewer and fewer staff hours, for subcontractors as well as the Institute on Disabilities; outreach is most affected by this. We are hoping that the influx of funds received in the last month of the prior two fiscal years and used to revitalize the inventory, particularly in the area of devices for communication, will reverse theessentially flat demand for the program. We anticipate these items (and those contributed through other sources) will begin circulating in the first quarter 2016-17.

The impact of the Lending Library goes beyond mere numbers: Assistive technology has the ability to make a substantial difference to individuals with disabilities in working, learning, and living.

Note: Data from the 14-15 program year appear throughout this report for the purpose of comparison, indicated in brackets.

Goal I: Maintain an inventory of assistive technology devices that meets the needs of Pennsylvanians with disabilities and that addresses individuals of all ages, all disabilities, and the activities in which they seek to improve participation, independence, comfort and safety.

  1. Circulate the devices in the inventory to Pennsylvanians withdisabilities, family members, providers, and others who need to use or learn about assistive technology devices. Receive and process at least 850 requests for items from the centralized inventory at Hiram G. Andrews Center (HGAC) annually, reflecting more than 400 different borrowers. Reach at least 250 “new” customers, e.g. those who are “first time ever” borrowers from PA’s AT Lending Library. Report on utilization of the program.

Note: Data in this section refers to activity related to borrowers that requested devices that circulate from the “centralized inventory” located at Hiram G. Andrews Center. Information about borrowers and equipment loaned from the “onsite” lending programs of the Assistive Technology Resource Centers (ATRCs) is noted in Goal I, Objective B.

As of June 30, 2016, there are 3078[3641] items (including 1681 [1902] different kinds of items) in the AT Lending Library housed at the Hiram G. Andrews Center (HGAC), the subcontractor for the maintenance and circulation of the centralized inventory. There were 1062[1068] separate requests for device loans received by regional Assistive Technology Resource Centers (ATRC), reviewed, and forwarded to HGAC for processing, exceeding this year’s modest target andrepresenting a flat level of activity. Almost all of these requests (1056[1018])were fulfilled, and more devices (1704 [1338) weresent out to borrowers; the remaining borrowers are waiting for the requested product or group of products.

There were540 uniqueborrowers (unduplicated count), exceeding the modest target for this year (400) and essentially level from last year [542].Four hundred fifty-one [450] were first-time borrowers, substantially exceeding the target (250),and again, essentially level from the prior year. The lack of growth in reaching new borrowers reflects a lack of investment in outreach.

Borrowers came from57[55]of the Commonwealth’s 67 counties (all except Adams, Cameron, Clarion, Clinton, Forest, McKean, Perry, Sullivan,Snyder and Tioga counties).Of the tencounties with no borrowers this year, all but two(Adams and Perry) are “non-metro” (according to Rural Urban Continuum Codes).

Who is making the request?

Data on the borrowers of Pennsylvania’s Assistive Technology Lending Library is obtained each time a separate request form to borrow item(s) is submitted (although more than one device may be requested on each form).

For each loan application submitted, borrowers identify their role. Requests for devices come from individuals with disabilities (or family members on their behalf) and service providers (for use with an individual with a disability). During the 2015-16 program year, 71[71]requests came from borrowers who identified themselves as “education” (including representatives from higher education), 11 [2] as “family members”, 187[124] as “service providers”,7[2] as “employer”, and28[56] as “other”. The vast majority of loan requests (758 [812]) orabout 71% [76%]) were made bypeople with disabilities.

What are the ages of borrowers?

Customers of Pennsylvania’s Assistive Technology Lending Library included persons of all ages. Data on age is available for about two-thirds of the borrowers, reflected in the following chart.

Age of Recipients

Age Category / Number
birth to 2 / 64[93]
3 to 5 / 92 [62]
6 to 21 / 111 [182]
22 to 64 / 286[250]
65 and older / 186[175]
Unknown / 323[306]
TOTAL / 1062[1038]

There is continuing demand for a program that serves Pennsylvanians of all ages. Of those for whom age data was known, approximately 36% [44%]of borrowers were 21 or younger,39% [33%] were adults 22 to 64, and 25% [23%]. were older adults (65+).

What is the purpose of the AT? Why borrow a device?

Seven hundred forty-one[755] borrowers indicated the equipment would help them “at home or in the community”; 164[229]requests were for loans for equipment that would help them “at school”, 142[52] borrowers reported the device would be for “work”, and 15 [31] borrowers reported the device would assist with using the phone or the computer. A more than 150 % increase in borrowers reporting the device would be for work is especially notable. Nine hundred thirty-nine[921] loans were for consumer device trial, 98[82] loans to professionals (e.g. faculty, service providers) for professional development, 28 [27] uses as an accommodation (e.g. for employment or public access), 40[29] uses as “loaners” (e.g. while the individual’s device was being repaired), and 22[11] “other” uses. Note more than one reason for borrowing could be identified; clearly, the ability to “try before you buy” is the overarching function filled by this program.

What is the racial/ethnic demographic of borrowers?

Although it is often uncomfortable to ask for and obtain information on a device recipient’s race, efforts continue to be made to collect this information in order to determine the extent to which the Lending Library reaches all Pennsylvanians with disabilities. More than 67% [80%]of the records included information on the race/ethnicity of borrowers. Based on the number of records of borrowers for whom race/ethnicity of the borrower was known and specified, almost 23% [19%] of borrowers identified their race/ethnicity as other than Caucasian.

Race/Ethnicity of Borrowers

Category / Number
Caucasian / 616[705]
Hispanic/
Latino / 45 [31]
African-American / 106 [85]
Asian / 22 [39]
other / 9[1]
unknown / 264 [207]
TOTAL / 1062 [1068]

What “systems” serve the borrowers?

Many borrowers are served by publicly-funded service “systems”. To the extent that the “system” is identified, we can infer that benefits accrue to that system (e.g. assistive technology that has been tried is less likely to be subsequently “abandoned”, therefore public monies are more wisely utilized; consumers of that system are better served). As the Lending Library is a primarily a state-funded program, it is of particular interest to see where state-funded systems are affected. Conversely, where borrowers are not “connected” to a service system, it may be more difficult for them to find funding to acquire their own devices and other supports for assistive technology. Borrowers are asked on the loan request form to select all systems from which they receive services (e.g. they may select more than one). Borrowers reported being served by the following systems:

“Systems” Serving Borrowers

Category / Number
Early Intervention / 134 [139]
Public School / 64 [100]
Private School / 11 [28]
Mental Health / 23 [17]
Office of Developmental Programs / 28[38]
Office of Vocational Rehabilitation / 60[47]
BVS / 63 [55]
Area Agencies on Aging/Senior
Centers / 38 [44]
None / 538[519]
Other / 103 [93]
TOTAL# responses / 1062 [1081]

The number of borrowers served by the Office of Developmental Programs continues to be lower than expected and declining. We do understand that, in at least some cases, a barrier may be the reluctance on the part of residential service providers to assume responsibility for devices borrowed by people with intellectual developmental disabilities who live in community living arrangements or larger congregate settings. Conversely, it is gratifying to see the increase of borrowing by or on behalf of BBVS consumers. We continue to serve students with disabilities (either because PaTTAN has a waiting list for the desired item, does not have the desired item, OR because other requirements were not met for that program [e.g. request was not made by “authorized” personnel), although these numbers have substantially declined. The number of borrowers who report being served by none of the listed service systems continues to surprise.

  1. Circulate devices from regional Assistive Technology Resource Centers (ATRCs), including arrangements fordelivery and pick up. Track and report on usage of ATRC on-site loans.

On-site loans remain an option to reduce shipping costs, as long as the borrower is able to go to the ATRC location and the ATRC has the desired product.

Although on-site lending is NOT supported with state ATLL funds, this activity compliments the role of the ATRC as a key resource for device loans. Some ATRCs, including the Institute on Disabilities, have augmented their collection of devices for onsite lending through other funding sources, where available. For items represented in both the centralized inventory and an ATRC’s onsite loan program, the ATRC adheres to its established policies and procedures for determining the source of the loan. ATRCs are permitted to use their state or federal funds (if needed) to support lending, e.g. mileage or postage to deliver/pick up loaned equipment.

Counting all sources of devices, a total of 290 [331] on-site loans were made from July 1, 2015 through June 30, 2016, as follows: PIAT –198 [220]; Three Rivers Center for Independent Living (7/1/2015 – 9/30/2015) –2[12]; CLASS (11); Roads to Freedom – 4 [66]; Tri-County Patriots for Independent Living – 16[8]; United Cerebral Palsy of Northeastern PA –25 [16]; United Cerebral Palsy of Central PA – 28 [1]; Community Resources for Independence –3 [7], and Good Shepherd Rehabilitation Hospital – 3 [1]. The differences in loan activity may be accounted for by the increasing availability of current devices through the centralized inventory.

  1. Implement mechanisms for reutilization or other re-distribution of

outdated or irreparable items, in order to reduce the amount of space required at HGAC. Track disposition of items in the centralized inventory purchased with state funds, e.g. distributed to individuals with disabilities or programs serving individuals with disabilities; or items beyond repair that are discarded.

Removing outdated or irreparable equipment from the centralized inventory reduces the needed space at the Hiram G. Andrews Center (with the potential of reducing space-associated costs). Review of items also assures an up-to-date program that does not have consumers borrowing and making decisions about equipment that is not currently sold.

During the reporting periodJuly 2015-June 2016, 40 [20]devices in working condition and meeting the criteria of no longer sold and no longer supported by the manufacturer were taken out of inventory, listed in the Reused and Exchanged Equipment Program online classifieds (REEP) and subsequently matched withconsumers who needed the AT and had no other resource for obtaining the devices. Eighteen additional speech generating devices have been distributed to the ALS Association of Western Pennsylvania and are pending a match to consumers in need. This activity saved consumers almost $30,000 [$13,223](if they had to buy similar devices “new”).Devices were provided at no cost, except for the cost of shipping, when applicable.

An additional 69 items have been identified for reuse and removed from the circulating inventory (and from the online equipment catalog) but have not yet been listed in the REEP Classifieds or otherwise redistributed. Forty-nine (49) devices that were beyond repair or so antiquated they were not usable were appropriated discarded.In collaboration with HGAC staff, considerable progress has been made this year in identifying items that have not circulated in the past year and determining their suitability for reuse or surplus.

The following stories illustrate the “new life” AT Lending Library equipment can have, even when it is no longer suitable for a “try before you buy” program:

A 73-year-old woman with MS contacted PIAT about a phone that had been a part of the Lending Library inventory but placed in REEP. She was able to obtain the adapted phone (Fortissimo) at no cost, and now has a telephone she can use in an emergency.

A consumer with cerebral palsy was in process of obtaining a new device but the appeals process was delaying his acquisition. In the meantime, he needed a way to communicate at his sister’s wedding, and a system for communicating during a business training program he was set to attend. These needs were met through his receipt of a Pathfinder, formerly a part of the Lending Library inventory, with ownership transferred to him through REEP.

  1. Identify items (current; in good operating condition) that are housed at HGAC that can be re-deployed to ATRCs; develop mechanisms for re-distributing these items for on-site lending, as per ATRCs’ request and for which they have capacity to store and circulate.

In September, 2015, 53 software titles valued at approximately $1500 were redistributed to ATRCs for demonstration or on-site lending.

Goal II: Provide referral services to borrowers who require additional supports in order to have a meaningful trial with the loaned device.

For items that require support, ATRCs may identify people with disabilities in need of help in setting up or using devices as they assist them in completing a loan application or during the review and processing of the application to borrow “high tech” devices. ATRCs typically explain the complexity or other characteristics (e.g. weight) of the identified devices, why, and what kind of support will be needed during the loan period in order to make an “informed decision”.

  1. Provide an interim contact to borrowers of complex devices to see if

they have the supports they need for a meaningful trial.

Each month, ATRCs call or otherwise contact people with disabilities or family members who have borrowed devices which require support to make sure the supports needed for a meaningful loan period have been obtained. This interim contact may result in the identification of borrowers who had listed a support person on the application but for whatever reason, that individual has been unable to provide the necessary supports or services. In some cases, the borrower will contact the ATRC (or HGAC) when s/he is experiencing problems in using the device.

  1. Provide borrowers who require additional supports with referrals to

qualified providers; provide information on potential funding sources for those services, including but not limited to the Griswold Scholarship Fund.

Although the numbers of consumers requesting support declined, the amount of support provided increased dramatically. Twenty-eight [40]individuals received almost 187 [148] hours of supporton 31 [71] devices, arranged or provided by ATRCs. Some borrowers received support on more than one item. Items requiring supports (where specified) were those for vision(10 [6]), hearing (10 [24]), speech communication (4 [18]), mobility, seating and position (1[12]), computer access (1 [6]).

Recipients of support services provided (or arranged) by ATRCs are asked to complete a support satisfaction survey upon conclusion of the service.