AT for Supported Employment - Day 2

Editor's Notes

• #2: Presenter: Make sure to have the main slide up on the screen when the participants come into the room. Spend some time welcoming each person and making them feel comfortable with this process.
• #8: Everyday Skills – Attainment Company
• #9: Presenter says: These accommodations will focus on tasks that are not computer related. Even though many jobs today have a computer component to them, there are still many types of jobs that a person can obtain that have little or nothing to do with a computer.
• #10: Presenter says: Commercially available products are the easiest way to potentially meet someone’s needs. The devices are already available, have been safety tested and can be purchased directly from a vendor. The picture on the left shows a variety of lifting platforms for manufacturing jobs. Back injuries account for a high percentage of job accommodations and this picture shows several different lifts for different types of tasks. The picture on the top right shows a rake with an ergonomic handle. These types of ergonomically designed devices have become more readily available due to the fact that our population is aging . These tools are now available from many home improvement stores. These tools come from – www.lifewithease.com $13.95 each or 3 for $39.95 The picture on the bottom right shows an automatic paper folding device. This desktop device folds papers into 3 panel folds for envelopes. This device will fold up to 3 sheets at once. It is available from Premier paper folder P6200 Paper Folder – www.officezone.com $128. Give an example of someone you worked with. Ex: We were asked if we could make a folding fixture, to help someone who had difficulty folding the paper straight We first looked at commercial devices– what would anyone in an office use? Does it faster, and everyone can use it.
• #11: Presenter says: In this step of the process, we are still using tools that can be purchased commercially but are trying to use them in creative ways. Sometimes that creativity involves combining devices not typically used together. Another way to use our creativity is to explore ways to use items already in the environment to meet the individual’s needs. This case study is a perfect example of this. Presenter: Go to next slide to describe this case.
• #12: Presenter says: This case highlights what can happen when a person is placed in a job without a team approach. This person was hired to be a greeter at the Aquarium. He works in the front at the visitor welcome desk and point visitors to the exhibits throughout the aquarium. He also needs to have access to the different literature for the aquarium so he can give this to people upon request. Presenter: Go to next slide to describe issues.
• #13: Presenter says: The issue that came up was with his access to the information desk itself. The desk is made up of several rounded sections of desk that are attached together to form a “donut” shaped desk. The staff members sit inside the desk and answer questions for visitors. All of the literature is stored inside the desk for distribution. The problem was that he was unable to access the interior of the desk in his power wheelchair. When the job developed visited this site, they measured the front entrance, which was wide enough for his wheelchair, but never bothered to measure the inside of the desk. Since it is a circle, the inside measurement was smaller than the outside measurement. When he arrived for his first day of work, his wheelchair got about half way into the desk before becoming stuck. His wheelchair was too large for this opening and caused his to be unable to complete his tasks. Because of this, he needed to sit outside the desk to complete his job, as you can see from the previous picture. Presenter: Go to next slide to discuss the solution.
• #14: Presenter says: The solution to the problem was to take one of the desk sections and mount it to heavy duty door hinges. This allows the entire section to swing away, which enlarges the opening considerably. He is now able to move into the desk in his wheelchair and then the entire section is moved back into place. One issue that had to be addressed was the opening and closing of this section. He would always be working with another staff member and each person was given training on how to open and close this desk. They all felt comfortable completing this task. Due to company policy, there were always two people in this desk at all times so there was never an issue that he would be left alone in there and unable to get out (in case of emergency)
• #15: Presenter says: This is a good example of the NON computer related job accommodation. Describe situation, and ask– what are some possible solutions? Then show video to show solution we came up with, and explain as the video plays This lady was unable to complete her job tasks at the Burger King for two reasons: The table was too high for her to access from her manual wheelchair . The table was on casters and the table would have been the perfect height by just removing the casters. Unfortunately, it was explained that when the fire inspector comes in to check for compliance, this table must be quickly wheeled into the freezer because it is positioned in front of the main circuit breaker panel. Instead of removing wheels, a second work shelf was attached to the table . This shelf is the wire variety sold at home depot and the shelf slides on a set of slides from a lateral file cabinet. The first set of slides were desk drawer slides and they were not strong enough to support the weight. the other issue was that she was unable to remember the steps to complete a salad . Each type of salad had different “fixins” which had to be placed in the salad in a certain order. We developed picture cards , which were laminated, that could be placed on her workstation to remind her of the steps of the process for each salad. Presenter: Click on the picture to start the video of this accommodation. Click the video as you are discussing so that the video is running in the background. There is no reason to have the sound up for this video. Make sure to highlight the idea of the modified paper towel rack at the end. This accommodation was completed by the site maintenance man – just another example of TEAM!
• #16: Presenter says: This is a good example of the NON computer related job accommodation. Describe situation, and ask– what are some possible solutions? Then show video to show solution we came up with, and explain as the video plays This lady was unable to complete her job tasks at the Burger King for two reasons: The table was too high for her to access from her manual wheelchair . The table was on casters and the table would have been the perfect height by just removing the casters. Unfortunately, it was explained that when the fire inspector comes in to check for compliance, this table must be quickly wheeled into the freezer because it is positioned in front of the main circuit breaker panel. Instead of removing wheels, a second work shelf was attached to the table . This shelf is the wire variety sold at home depot and the shelf slides on a set of slides from a lateral file cabinet. The first set of slides were desk drawer slides and they were not strong enough to support the weight. the other issue was that she was unable to remember the steps to complete a salad . Each type of salad had different “fixins” which had to be placed in the salad in a certain order. We developed picture cards , which were laminated, that could be placed on her workstation to remind her of the steps of the process for each salad. Presenter: Click on the picture to start the video of this accommodation. Click the video as you are discussing so that the video is running in the background. There is no reason to have the sound up for this video. Make sure to highlight the idea of the modified paper towel rack at the end. This accommodation was completed by the site maintenance man – just another example of TEAM!
• #17: Presenter says: Let’s now talk about the most customized aspect of job accommodations. This type of accommodation is often the most expensive because of the design and construction time involved in making sure the device meets the unique needs of the consumer. The device shown on the slide was designed for a lady who worked in a department store . Her job task was to take pants from the supplier and attach the clothes hanger to them. The issue was that she was only able to use her right hand and the type of clothes hanger needed required a pinch in order to open the clips. She was unable to open the clips and slide the pants in simultaneously. In order to meet her needs, we designed a fixture that could velcro to the table. There was a space to place the hanger in. then she would pull the handle down to the tabletop and lock it in place. This would open the clips and keep them open. Then she could simply slide the pants into the open clips. Once the pants were positioned, she would pull the lever towards her and the clips would close on the pants.
• #18: Presenter: Make sure to take one minute to make sure that there are no questions before moving to the next section.
• #20: Presenter says: The first area we will be discussing today is the area of workstation ergonomics. As we discussed in the first session when we looked at computer access tools, proper positioning is critical when providing a job accommodation and the quote on the slide from the Secretary of Labor demonstrates how important this topic really is. Presenter: Read the quote aloud. Question to Audience (to establish relevance of this topic with them): About what percentage of people do you see who have issues with pain (back injury, repetitive strain injury)?
• #21: Presenter says: The field of ergonomics is huge so we will be focusing our discussion today on workstation ergonomics. Within the scope of workstation ergonomics, we will address the areas of the workstation, the work process and environmental factors that may impact someone at work.
• #22: Workbook: Refer to Appendix 5 – “OSHA Regulations 1900-910 Ergonomics Program Standard” Presenter says: Now we will explore examples of workstations, both good and bad. Your job is to review the pictures provided and complete the checklist provided on the next several pages. Some of the examples have consumers seated at the workstations, others do not. You may need to imagine what the set-up would look like with a person sitting there. If there is an area of the checklist you are unable to complete because you don’t have enough information, list that information on page 3 of the checklist. We will discuss these case studies throughout the remainder of the presentation so keep your information handy. Presenter: Move through the group during the activity and provide guidance to the groups. Use the Cool Timer software to project the time remaining in this activity. Tell the group the will have 10-15 minutes to complete this activity.
• #25: Presenter says: When we think about ergonomics, we aren’t only speaking about a chair. There are a variety of areas that all have to work together to support the person while they complete their work tasks. These include the chair, work surface, the keyboard and mouse, monitor and any additional positioning devices that may be necessary. We will go into each of these areas further in the upcoming slides.
• #26: Activity – Split into groups of 3 – look at one of the ergo workstations and then report back thru the OSHA worksheet on the positive aspects of the workstation.
• #27: Presenter says: The first thing everyone wants to look at with ergonomics is the chair. Just because is said “ergonomic chair” on the box doesn’t mean it will be correct for the person you are working with. Chairs come in as many shapes and sizes as people do. It is important to match the needs of the person to the features of the chair. The slide shows a sit stand stool which is a unique solution for someone who needs support while in multiple positions. The stool allows the man to be properly positioned while completing the task at that machine which should reduce the likelihood of injury. The other chair shown in the slide is more in tune with what most of us think of as an ergonomic chair. The chair has a wheeled base, height adjustable back and armrests. What else do you notice about this chair? The seat cushion is molded to provide contoured support while the person is seated. Also, there are three levers on the side. Most typical chairs have only one lever – for height adjustment. This chair also provides the user with back angle adjustments and seat tilt adjustments. These additional adjustments will create a system that can be customized more in-depth to the user’s needs. Also remember that once the chair is positioned properly – a footrest may be required to position the feet
• #28: Presenter says: The next area we will discuss with regards to ergonomics is the work surface itself. How many of us are working on a desk that was even designed for computer use? There are times where we walk into a job situation and the consumer is working on a desk that was designed for writing, not to support a computer and keyboard and mouse. The surfaces shown in this slide are very specific in their application. The picture on the left is a wheelchair workstation that has a track system mounted to the floor in front of it. The person rolls up a small ramp and then they are able to move laterally across the table without moving their wheelchair. The picture on the right is a small laptop stand that can be moved up to the consumer.
• #29: Presenter says: We discussed keyboards and mice in the first session but it is important to revisit during our discussion of ergonomics. The placement of the devices is critical in order to maintain the neutral wrist position needed to reduce the possibility of RSIs.
• #30: Presenter says: With the monitor, one of the most important aspects in the distance away from the consumer. We do not want the monitor too close or too far away from the person – an arm’s length away is a good guide. The top of the monitor should be at or just below eye level. Glare is important to consider also. Try experimenting with font sizes, and colors. Also don’t forget about anti-glare filters.
• #31: Presenter says: Even after providing a quality chair and desk surface, additional positioning supports may be necessary to ensure safe computing. These positioning aids can be as simple as a foot rest to provide lower body positioning. These are also a variety of tools available to provide positioning support to the upper extremities. These are wrist rests and adjustable forearm supports. As with all positioning , we are striving for neutral position of the wrists and shoulders to reduce strain.
• #32: Presenter says: Here is an example of a specialized setup for an employee and their workstation. This lady needed to be reclined while completing her Information and referral job responsibilities. The standard ergonomic chair she was provided was not giving enough support throughout the tasks and she needed to take frequent breaks throughout the day. The employer went and purchased this chair and desk for her hoping to meet her needs. The AT specialist was called in because the consumer was not able to independently get in and out of the chair. This was because the chair was so large and had no casters on the bottom for movement. The desk positioned her computer in the proper position once she was reclined back in her new chair. In order to have the computer positioned properly for her access, she needed a way to move the chair under the desk independently.
• #33: Presenter says: The solution to this problem was to fabricate a custom rotating base for the office chair. This enabled her to swing the chair away from the desk and transfer into the chair. Once she was positioned in the chair, she could swivel around and be positioned at her computer to complete her tasks. Since the entire chair was now on a platform, she was able to independently move in and out of her chair throughout the work day.
• #34: Presenter says: Just as important as the equipment, is the process of how work gets completed. This involves looking at the tasks that need to be completed and ensuring that the consumer is maximizing efficiency and help to facilitate work flow. In addition to looking at the tasks, the person may benefit from some simple items to assist with task completion. The pictures above show two different styles of document holders. Two different positions- which to use? - depends on work task If person looks at keyboard (not touch-typist), may be best to place copy between keyboard and screen If person is touch typist, then it may be a matter of personal preference– looking down more, or looking over more
• #35: Presenter says: Environmental factors also may impact the persons ability to complete job tasks. We will discuss each of these areas in detail in the upcoming slides.
• #36: Presenter says: The simplest way to reduce the frequency of RSIs in the workplace is to take frequent breaks. Just taking a 15 second break from typing periodically can dramatically reduce the strain on a person’s body. Some companies have an ergonomic program in place that encourages employees to complete stretching exercises. Some of the benefits of performing exercises: reduce muscle tension, increase flexibility, prevent injuries, promote circulation The picture shown on the slide is from a Stretch Break software tool that can be installed on the computer. At a pre-determined time interval, the software pops up and leads the employee through a series of stretches to promote safe computing.
• #37: Presenter: Make sure to take one minute to make sure that there are no questions before moving to the next section. No questions – enjoy the activity for next week. I am looking forward to talking with you in the discussion forum.
• #38: Activity – Split into groups of 3 – take 60 seconds to come up with challenges which may require job accommodations. Think outside of the box. With the Employment First Initiative, we are going to see individuals with a wider and more severe range of disabilities Once the lists are complete – talk about the disabilities we might see more of and types of accommodations, which might be necessary. Talk about how our limited knowledge of AT will hold us and the consumer back.
• #39: Presenter says: Now that we have discussed the input into the computer, lets spend a couple minutes discussing some software tools that could assist people with either physical or learning disabilities.
• #40: Presenter says: For people that struggle with reading and writing, perhaps providing auditory support may help them. There are many tools available to enable the computer to read information back to the person to assist with comprehension. One example of this type of tool is a scan and read software tool such as Kurzweil 3000. This tool allows the person to scan in a page directly into the computer and have the computer read this information back. Presenter: Perform a quick demonstration of features of Kurzweil. Presenter says: As for word predication, this type of tool will assist with completion of words by providing a list of words that the computer “thinks” the person is trying to type. If the word is on the list, the person can simply click the word with the mouse or select a corresponding number and the computer types the remainder of the word. This type of tool can increase someone’s typing speed considerably. Presenter: If time permits, show a quick demonstration of word prediction, either Co:Writer or WordQ
• #41: Presenter says: A software solution that we are asked about all the time is using voice recognition software to enable a person to type into the computer with their voice. While on the surface people expect this to be a easy solution, it is actually one of the more difficult tools to use effectively. There is more to this tool than simply “Talking”. Instead, the person has to complete this entire cycle for each sentence they type. First the person must think about what they want to type. Then they must compose the sentence in their head. For someone people, they may not have the skills to construct a sentence in their head. Now, they speak the sentence into the computer. Once the sentence is in the computer they have to read what the computer wrote and check to make sure it is accurate. This step may become a hurdle for an individual that does not read. If that is the case, they may need auditory support like we discussed in the last slide. If the computer typed the wrong information, the person must now correct that information. This requires various voice commands and formatting skills. Now after all that, the person can finally move onto the next sentence and the whole process starts again. Presenter: If there is time, either give a quick demonstration of Dragon or have someone from the crowd use it. If you pick a volunteer, don’t do voice training, show how the program works right out of the box.
• #43: Presenter says: The final piece of the puzzle we will discuss in this training is the idea of implementation of assistive technology. This is the stage where we assemble the pieces and make sure that the technology meets the consumer’s needs. As we can see in the picture above, the technology solution is not complete until we have matched the consumer’s needs, with the technology tool and identified the implementation strategies.
• #44: Presenter says: This slide shows us the steps we, as the team, need to address to achieve successful technology implementation. We will address each of these areas in the upcoming slides.
• #45: Workbook: Refer to Appendix 3 – “The Assistive Technology Team” Presenter says: We discussed this in session 1 but the ideal is just as important during this phase of the accommodation. We are not working in a vacuum. For each technology accommodation, there is a team in place to ensure success. Who are the members of our team? [AFTER THE GROUP DISCUSSION] It is important to remember that every team will be different, just like every consumer’s needs are different. Depending on the circumstances, the team may be very small (only two members) or very large. Also the team size may change throughout the accommodation, depending on the need being addressed. Remember that the team is dynamic and not static. Now that we identified the members of our team, let’s focus on the other issues that can surround the team. Roles and responsibilities for each team members should be identified to ensure that all the areas needed for success are being addressed. As part of any team, there will be times when people don’t agree. This is the part where it is important to practice the strategies of conflict resolution and consensus building to ensure successful collaboration. Presenter: Facilitate a short group discussion about the members of the team. Make sure to remind participants, if it does not come up in conversation, that the team is larger than the consumer and the counselor.
• #46: Workbook: Refer to Appendix 6 – “Assistive Technology Trial Period Plan for Vocational Rehabilitation” Refer to Appendix 7 – “Data Collection During Trial Period for Vocational Rehabilitation” Presenter says: This step is critical for a successful technology solution. Unfortunately, this step is sometimes skipped and we have seen how this leads to device abandonment. In order to make sure that a tool is effective for a consumer, we need to try that tool out while completing the same types of tasks that the person will be doing on a daily basis to complete their vocational objective. As we can see on the form provided at the back of your workbook, Appendix 6 - “Assistive Technology Trial Period Plan for Vocational Rehabilitation” we, as a team, need to decide on a plan for the trial period. Decide on Devices to try: We first need to decide on devices to try. If we have completed the SETT framework already, we should have a good idea of the tools we want to try. Determine environments / activities: Next we identify the environments for the trial period. This was also addressed earlier in the SETT framework. The activities we complete during the trial are very important. The activities should be meaningful and motivating, reflect key environments and especially be consistent across trials. If the activities are not consistent, we will not be able to evaluate success at the end of the trial periods. Obtain equipment: There are a couple ways to obtain equipment for a trial period without buying it. First, our department will loan technology tools to consumers that are evaluated through our service. That way, tools that are identified during the evaluation period can be tried to determined effectiveness. A second strategy is to contact manufacturers of the technology. These companies will sometimes have a loan program that you can access. Be aware that this may be free or there may be a cost associated with the loan. Also, loan periods will vary depending on the company. Set goals for trial period: After we get the tools we want to try, we set goals for the trial period. This is where we decide what will be the indicator of success for this trial. As you can see from the trial plan form, there are several measures of effectiveness for the trial period. Data Collection: As you can see from the data collection form, Appendix 7 - “Data Collection During Trial Period for Vocational Rehabilitation”, we need to track success and failure throughout the trial period to use at the end when we determine which tool best meets the consumers needs. Timelines: Finally we must identify the time period for the trial. The trial must have a beginning and end – it can’t drag on indefinitely. A typical trial period is 30 days. Sometimes the trial can be longer or shorter, depending on the consumer, the task being completed or the technology tool. if the technology tool is especially complicate, we may extend the trial period to accommodate the learning curve for the device.
• #47: Presenter says: Since we are discussing job accommodations through vocational rehabilitation, that would typically be the funding source for technology purchases. Sometimes, in order to obtain the funding for the device, additional information may be required. For example, for mobility devices, sometimes medical justification is needed if you are exploring alternate funding sources. Ordering equipment is sometimes a difficult process. There have been instances in the past where a technology solution was delayed because the vendor was not state approved. This forced the counselor to search for alternate vendors or sometimes even different tools that could be purchased through a state approved vendor. A new service that our department has been providing to VR counselors has been device purchasing. With this service, our technology staff will provide the counselor with a detailed summary of the devices to be purchased along with a total purchase price. Once the counselor provides a voucher for the purchase amount, our staff completes the device ordering. This has been reducing the instances where a consumer has to wait for extended periods of time to receive the necessary technology tools to complete their jobs. If you would like to discuss this service further, please talk to me after the session. I would be happy to provide you with additional details.
• #48: Presenter says: Finally, the consumer has been evaluated, the equipment has been purchased, and we are finished! Not quite. Technology tools without training are often not successful. No matter how simple the technology may appear, training will always be necessary. Some more high tech solutions (computers software, etc.) may require more training but even low tech solutions require some training. Consumers may not be used to using technology to complete tasks and will require a support system during the initial phase of use. We all know that technology breaks. It doesn’t matter how simple or complex the device is – things break! It is important to have a plan in place for WHEN the device breaks, not IF the device breaks. If a piece of equipment is very expensive, you may want to explore the idea of extended warranties. When technology is new – everyone wants to use it. The key to success is whether the person is still using the technology 3 months later. That is where follow up and follow along come into play. Follow up happens within the first couple months of a technology solution. Follow along happens at a longer interval (6 months, 1 year, etc.) In order to ensure that the tool continues to meet the person’s needs we need to check in with them. Sometimes we will find out that the tool has broken and the person doesn’t know the steps to repair the device. Other times, needs or abilities have changed and the device may not be appropriate anymore. Technology solutions are not forever – a person’s technology needs should be addressed periodically to make sure they are remaining successful.
• #49: Presenter: Make sure to take one minute to make sure that there are no questions before moving to the next section. No questions – enjoy the activity for next week. I am looking forward to talking with you in the discussion forum.
• #51: Presenter: Make sure to leave enough time for participants to complete their evaluation forms. Presenter says: Thank you for your attention throughout this training. We hope you have enjoyed this experience. Please take a few minutes and complete the evaluation form. Your comments will help us improve this training and help us develop new and exciting training opportunities in the future.
• #53: MAKE SURE TO ADD DATE OF SECOND TRAINING SESSION TO THE POWERPOINT SLIDE Presenter says: Thank you for your attention today. We are looking forward to seeing you again at the second session.