Chapter 5
Rapid Literature Review on AT in Education
The design, marketing, and use of AT must be understood in the context of technology used in schools (i.e., educational technology) as well as technology used in society (i.e., mainstream technology; see Figure 1). Since the late 1990s and the development of a paradigm known as universal design for learning, designers have sought to understand the specialised needs of individuals with disabilities in order to design products that are “usable by the widest range of people operating in the widest range of situations as is commercially practical” (Vanderheiden, 2000).
This context is important to understand since increasingly AT is not always a separate specialised product only used by people with disabilities (e.g., smartphone, tablet). For example, graphic organisers may be introduced to all pupils and students in the context of teaching writing strategies and therefore may be considered an educational technology. Whereas many students will abandon this software after they have internalised the prewriting strategies they have learned from the graphic organiser, some students with a disability will require on-going use of these tools as AT because they are unable to complete the task without it. This chapter will highlight issues from the rapid review of the literature concerning what is known about effective AT implementation.
The equitable implementation of technology in education requires an understanding of system-level factors influencing how technology is acquired and used in classrooms. Based on a review of the literature, the Jefferson Education Exchange (2019) summarized 12 clusters of 70 variables that have been identified in the research literature as impacting the effectiveness of educational technologies in education (see Figure 6). This comprehensive framework has potential application in the field of AT to supplement the many individual variables have been previously identified as facilitators or barriers (Boot, et al., 2018).
Figure 6
70 Variables Identified as Influencing the Effectiveness of Educational Technology
To-date, no studies have been identified that examine the compatibility and/or friction between educational technology (ET) and assistive technology (AT) service delivery systems within schools that are typically siloed as different administrative and service delivery units (Negrea, 2019). Yet, strong leadership has offered vision and guidance when professional organizations (Fletcher, et al., 2014) and educational agencies (Martin, et al., 2019; Maryland State Department of Education, 2011) take the lead in articulating the benefits associated with universal accessibility within educational systems.
Without a system of universal screening for AT (see section 4.1), AT devices and services are primarily provided in a reactive fashion. That is, someone within the educational system must advocate for a struggling pupil or student by making a referral for an AT assessment. Based on those findings, recommendations may or may not be made to provide AT. This state of practice is revealed in vastly different AT prevalence figures from many different localities and contributes to inequitable access and use of AT.
Educational systems may manage their AT personnel and services through one of three primary service delivery models. For example, in some jurisdictions, AT is a component of special education services. This historical approach tends to silo AT and often produces friction between AT and educational technology (ET) personnel as they debate the merits of standardised technology tools provided to all staff and students and specialised tools that may be needed by only a single student. In this model, budget, personnel, and training are all siloed in either special education or general education with very little collaboration between the units.
A second model occurs in situations where the status of AT has been elevated by school leadership who set priorities for inclusive education or multi-tier support systems (MTSS) where the general education classroom is viewed as the home unit for all students with a goal of making differences ordinary. In this model, all students, for example, will learn to write. However, some students will use a standard word processor while other students may use word prediction tools to help them overcome severe spelling disabilities or speech to text tools to allow them to dictate their essay to overcome the inability to use the standard keyboard and mouse. This approach to AT devices and services often views technology as a toolkit such that the individual components can be swapped out as needed. In this model, budget, personnel, and training are all resources that are called upon to solve technology access problems with extensive collaboration to all stakeholders.
A third model represents an evolution of accessibility. It may be represented as a component of a Multi-Tiered Support System (MTSS) model or a claim of status for seeking to implement state-of-the-art universal usability. In this model, AT and ET personnel work intimately together to procure universally accessible technologies (that is, accessible out of the box: accessibility features are built-into products that just need to be turned on as needed). In this model, there is no longer a single accessible computer station in the classroom or library, but rather, all computer workstations are fully accessible and a student can use any computer. Furthermore, if a pupil or student uses specialised devices like an alternative keyboard or mouse, these devices will plug right in and work instantly. In some cases, a school jurisdiction may refer to this type of service delivery model as Universal Design for Learning (UDL) but this term lacks a clear operational definition so it is impossible to discern its full implications as a service delivery system.
To-date, there are no research studies examining the efficacy of various AT service delivery systems/models. The literature features numerous studies about user satisfaction with AT devices and services that serve as an inadequate proxy for AT outcomes. As a result, there is a considerable need for AT research that focuses on quantitative measures of return on investment (ROI) and performance under varying conditions. Studies by Koester and Arthanat (2018a, 2018b)offer a model for AT research that advance the profession’s empirical evidence base while simultaneously providing critical data for consumer decision-making about what works rather than simply relying on user preferences.
A number of factors are thought to be essential for the successful implementation of AT in educational settings Karlsson, Johnston, & Barker, 2018). However, the quality of these data are often at the level of expert opinion rather than empirical evaluation of alternative AT service delivery models. With that caveat, stakeholders are encouraged to consider the following components necessary to ensure successful AT implementation:
• Develop Personnel Preparation Pathways that Provide General AT Knowledge
Teachers, speech therapists, occupational therapists, and special education administrators need pre-service (Bausch & Ault, 2012; Judge & Simms, 2009; Medola, et al., 2018; Smith et al., 2018) and in-service (Reed, Kaplan, & Bowser, 2009) education concerning their roles and responsibilities for team-based AT decision-making in order to understand who might need AT, how to evaluate various AT interventions, and the types of AT outcomes that should be anticipated. Without this common professional knowledge in every school, it is unlike that societal goals for AT use will be achieved. This component is comparable to the extensive research base in education technology, that is, teachers need training in order to maximise the effectiveness of technology.
• Develop Personnel Preparation Pathways that Develop Specialised AT Knowledge
Beyond the general awareness and knowledge described above, it is essential that leadership pathways be developed for school-based personnel to develop AT expertise. AT leadership personnel often serve as the AT diagnostic leader or the AT team leader. It is common to have an AT Specialist at the jurisdiction level and desirable to have an AT Specialist within each school building. Without a local AT leader, it is unlikely that there will be consistency across levels, units, or programs (Breslin Larson & Carl, 2019; Courduff, Szapkiw, & Wendt, 2016).
• Establish AT Teams
Given the transdisciplinary nature of AT, teams are professionals are required to evaluate the need for AT and develop AT implementation plans. Beyond the professional development required in the previous two components, team members will need load reductions to enable them to meet, conduct AT evaluations, and support AT implementation. Without a building-level AT team, the likelihood of successful AT implementation is quite limited (Desideri, et al., 2014; Lamontagne, Routhier, & Auger, 2013).
• Standardise AT Evaluation Procedures and Protocols
There is little consistency between educational agencies about how they evaluate the need for AT. Whereas there are a number of AT assessment models, few have been empirically validated. Similarly, there are few standardised AT assessment instruments or protocols. Best practice indicates that students should experience multiple AT devices in order to collect data about which intervention might be most effective (Corradi, Scherer, & Presti, 2012; Desideri, et al., 2014; Silverman & Smith, 2006). There is an urgent need to standardise the AT evaluation process in order to ensure the equitable distribution of AT to all pupils and students who could benefit and move beyond the distribution in the hope that it will help because “nothing else to-date has shown benefit.”
• Connect AT Devices, AT Services, with AT Outcomes
AT devices by themselves are generally insufficient to promote the functional outcomes desired (Hoogerwerf, et al., 2017; Layton, et al., 2016; Lenker, et al., 2019; Satterfield, 2016). As a result, significant attention must also be provided to ensuring appropriate AT services are instituted. Increased attention must be devoted to measuring the outcomes and benefits of AT use to expand the AT evidence base.
The Need for Accessible Educational Materials (AEM)
While, historically, classroom materials have come in a "one size fits all" form and method of delivery, digital content can be adjusted in real time to meet diverse student needs. In order to harness this potential, however, digital material must be the result of purposeful design and planning that takes into account considerations of accessibility at the outset. State and district policies regarding digital content, including on OER [Open Educational Resources], can help facilitate this. – Fletcher et al., (2014)
The ability to access and use AT is essential, but not sufficient, for closing the achievement gap experienced by pupils and students with special educational needs and disabilities. This insight has prompted considerable attention to the nature of inaccessible curricula. Historically, the problem was a textbook with its rigid fixed format (Wiazowski, 2010). The evolution of digital learning materials, as well as the wealth of information available – or inaccessible – via the World Wide Web, has helped educators appreciate the value and flexibility of digital text (e.g., change the font, size, copy, paste, summarise, convert from text to speech) for diverse learners (McLaren, 2018).
In this study, 49 documents addressing AEM were identified and the evidence levels were as follows: 33 demonstrates a rationale, and 16 emerging. While there is much advocacy about the need for accessible educational materials (i.e., digital curriculum, online learning environments), little attention has focused on the relationship between AEM and AT, and empirical work in this area is quite limited. Nonetheless, advocacy for AEM is a necessary component of AT devices and service systems. The importance of accessible educational materials cannot be underestimated during the COVID-19 pandemic and the shift to online instruction where pupils and students with special needs and disabilities may experience (1) barriers in online learning management systems, (2) multimedia and web pages that are not accessible, and/or documents that are not accessible, and (3) not having appropriate AT to support guided and independent engagement in learning activities.
AT is an under-utilised intervention to provide pupils and students with special needs and disabilities a means for accessing and engaging in the curriculum in ways that are representative of the ubiquitous nature of technology in society. Realising the potential of assistive technology will required the coordinated efforts of students, parents, educators, administrators, policymakers, developers, service providers, and researchers to examine policy, products, personnel, and provision systems (Desmond, et al., 2018; Durocher, et al., 2019). Tactics known as Frugal Innovation (Cadeddu et al., 2019) may be particularly helpful during and after the COVID-19 pandemic that has caused significant budget contractions.
However, let us be mindful that advances in universal usability have provided access tools on every smartphone, computer tablet, laptop, and desktop computer. Parents and educators are encouraged to explore the accessibility features on their devices as a critical first step in locating appropriate AT (Hemphill et al., 2019). The development and expansion of formal AT assessment procedures and systems in every school jurisdiction will be an essential step in identifying pupils and students in need of AT. The establishment of AT Seedbeds will be an important investment to assist developers, educators, administrators, policymakers, and researchers in understanding what types of AT devices and services help which types of students. Additional attention to the pre-service and in-service teacher professional development is a critical need since the lack of awareness about AT is a major obstacle for students to receive appropriate AT devices and services. Finally, there is an urgent need for on-going data collection about AT use and research on measuring AT outcomes.
The Need for Technology
…disability is a rich and indispensable site and “test bed” for how societies can confront technology for better futures. – Goggin, Ellis, & Hawkins, (2019), p. 298.
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