University Support in Technology Evaluation  and Development

This project is made possible with funding from the Ohio Department of Developmental Disabilities.

Scope of Work

Introduction

Fox and Boyles conducted a study in which they discovered only 54% of individuals with a disability use the internet compared with 81% of individuals who do not identify having a disability (Fox & Boyles, 2012). What this illustrates is that having a disability may be a contributing factor that prevents one from having access to technology. It reveals a need to involve those with disabilities in navigating technological advancement for their own advantage.

Technology has influenced the lives of nearly everyone in one manner or another. Most of us take it for granted, perhaps not even noticing the extent to which our everyday activities are either completely reliant upon technological advancement or have just been made significantly easier. Often, technology is developed in a way in which persons with developmental disabilities are excluded from the digital environment. In an age where every year we are more integrated into a global digital society, it is imperative that people with developmental disabilities are not left behind. If people with disabilities cannot utilize the technology others take for granted then they will be left disenfranchised from the way in which society will operate in the future.

Not only is there a need for technology to become more accessible and available for those who have a disability, there is an opportunity to use technology to help promote a more inclusive life for people with developmental disabilities. Currently, in Ohio alone, over 90,000 people with intellectual and developmental disabilities receive supports from the Ohio Department of Developmental Disabilities (DODD). In recent years, technological advancement has provided an opportunity for supported living services to become in many ways less intrusive and foster a greater independence.

One such advance is the use of remote monitoring. Remote monitoring means the monitoring of an individual in his or her home by using one or more of the following systems: live audio feed, sensor technology, radio frequency identification, web-based monitoring system, video feed, or other devices. The system includes devices to engage in live two-way communication with the individual receiving services as described in the Individual Service Plan. While remote monitoring is available as an alternative to having staff in the home for many people, at present, only 170 individuals take advantage of this service.

What is the Technology Project?

The Technology Project is a collaborative enterprise between the Department of Developmental Disabilities and The Ohio State University Nisonger Center. The project aims to take an in-depth look at the role technology, including remote monitoring, plays in the lives of people with developmental disabilities and their families, create a vision for how the use of technology may be improved and expanded upon, and identify technological advances that might benefit people with developmental disabilities by increasing their independence.

Activities

The Technology Project can be separated into 3 parts:

  • Conduct Focus Groups and Interviews regarding remote monitoring
  • Conduct a national review of technologies that currently enable people with developmental disabilities to live and participate in their communities with less direct support from caregivers
  • Identify areas of future technology development that might benefit people with developmental disabilities

The focus groups and interviews will provide detailed insight into the reception and use of Remote Monitoring. We will discuss the topic with people who have used the service, people who are closely associated with those using the service, and people who have never used it. This will provide insight into what people like and dislike about Remote Monitoring as well as provide insight into what sort of stigmas may be associated with the service. With this information Remote Monitoring will be expanded and refined.

In order to write a national review of technology, external resources will be leveraged to gain an understanding of the technology landscape. These resources will be everything from news articles to interviews with experts and technology conferences. The review will document the use and reception of technology as well as an analysis of its accessibility and ability to facilitate independence among persons with developmental disabilities.

Through the Technology Project, a plan will be developed to introduce an independence facilitating technology into the lives of people with developmental disabilities.

What are examples of independence facilitating technology?

Technology that provides support to someone with a disability is called assistive technology. There are many different disabilities and there are assistive technologies that support many of them. Examples include: tools used in speech therapy to teach an individual how to initiate specific phonetic sounds; switches which are easy to use buttons for people that lack mobility or the ability to use complicated technological instruments; apps that help someone to communicate; a man who has a vision impairment who uses Google Glass to live stream his daily activities.

The assistive technology sought by the Technology Project is something that facilitates independent living while reducing the person’s reliance on the need for direct-support staff. To this end there are apps that prompt one when to get off of the bus, watches that will send GPS coordinates to a trusted contact, cars that drive themselves, devices that will send notifications to one’s phone when food has cooled to an appropriate temperature, technology that will shut down appliances if they are left on too long, etc. There is a plethora of examples of technology that would meet our purpose in some way. The Technology Project aims to find one that can meet the most need and facilitate the greatest amount of independence.

Conclusion

Technology has already shaped the way we communicate and live. With the rapid introduction of autonomous cars, the internet of things, virtual and augmented reality, and wearable technology, the digital landscape and its influence on our lives is about to change in a way that is unparalleled to any change we have experienced to date. The new landscape has potential to be a practical and beneficial alteration. It is an exciting time – one in which people with developmental disabilities will have the opportunity to live more independent and socially engaged lives.

The Ohio State University is a leader in technological innovation and research. It is the perfect organization to recognize the affect technology can have on persons with developmental disabilities.

Partners

  • The Ohio Department of Developmental Disabilities
  • The Ohio State University, Nisonger Center – University Center for Excellence in Developmental Disabilities

Project Team

Jordan Wagner, Technology Project Coordinator.
Christopher Steiner, Support Analyst.
Daniel K. Davies, Project Consultant – Founder and President of AbleLink Technologies.

Marc J. Tassé, Ph.D., Project PI.

References

Fox, Susannah, and Jan Lauren Boyles. 2012. Disability in the Digital Age. Washington, DC: Pew Research Center. http://www.pewinternet.org/2012/08/06/disability-in-the-digital-age/.

FOR MORE INFORMATION, CONTACT:

Jordan B. Wagner
Coordinator, Technology Project
Tel.: (614) 688-3155 Office

Technology Project Focus Groups

 

Focus group information

We will be conducting focus groups around Ohio. The goal of these focus groups is to better understand how remote monitoring services may be improved upon. Have you used remote monitoring services? Have you refused remote monitoring services? Do you have a family member who uses remote monitoring? We want to discuss this with you in a focus groups. By clicking here, you will be redirected to a survey that will help determine if you are a candidate for our focus groups.

Remote Monitoring: Background

Remote monitoring services have been in use in the state of Ohio since 2011.  This service is available through the Medicaid-funded Home and Community Based Services (HCBS) waiver to support community living of individuals with developmental disabilities.  There are three distinct HCBS waiver programs for people with developmental disabilities in Ohio: Self Waiver, Level 1 Waiver, and Individual Options Waiver.  The operations of all three of these HCBS waiver programs are overseen by the Ohio Department of Developmental Disabilities (DODD).  All the HCBS waiver programs in Ohio offer the use of remote monitoring services.

Remote monitoring services involve the use of technology to transmit real-time information to the individual’s service provider to support this individual to live safely and independently in his or her home. The use of remote monitoring services is developed by the individual with developmental disabilities, his/her guardian, county board service coordinator, and other members of the individual’s support planning team. Remote monitoring services include technology such as: movement detector sensors, heat sensors, magnetic sensors, radio frequency identification, and video/audio communication devices. The data and information from these devices are transferred through an encrypted and highly secured mode of transmission to a remote monitoring site that monitors these sensors and devices and implements a specific prescribed protocol as needed.  For example, if a magnetic detector on the front door indicates that the door has been left open for a longer than a specified period of time or is unlocked after a specified time of day, a message or reminder is sent to the individual/home, family member, and/or direct care provider who will verify that everything is OK. Communication between the monitoring center and the individual in the home can be through an audio-only device or, more frequently, through an audio & video communication system.

Purdue University was tasked with comparing remote monitoring supports with supports provided by direct support professionals. Their findings showed that “While both types of supports resulted in consumers completing tasks, results indicated consumers [with developmental disabilities] achieved slightly more independence when prompted by the telecare [remote monitoring] support provider.” The study also reported that “… telecare supports resulted in greater duration for task completion per consumer” (Taber-Doughty, Brewer, & Kubik, 2010). In a second study conducted by the same team of researchers, the investigators looked at perceived safety when using remote monitoring. In this study they found that the adults with developmental disabilities reported feelings of greater privacy and greater safety when using remote monitoring versus being with direct support staff (Brewer, Kubik, & Taber-Doughty, 2010).

According to the American Network of Community Options and Resource’s 2017 Workforce paper, “the inability to retain qualified staff as Direct Service Professionals is a public health crisis.” The paper cites a 45% turnover rate for staff in this field. Recruiting, training, and retaining direct support professionals in the field of developmental disabilities is a growing concern.  Technology can provide powerful tools, both for enhancing independence and enabling cost-effective care alternatives, to help fill this gap.

References:

American Network of Community Options and Resources (2017). Addressing the disability services workforce crisis of the 21st century: electronic Version. Retrieved on 3/27/2017 from: https://cqrcengage.com/ancor/file/ZuL1zlyZ3mE/Workforce%20White%20Paper%20-%20Final%20-%20hyperlinked%20version.pdf

Brewer, J. L., Kubik, S., & Taber-Doughty, T. (2010). Safety assessment of a home-based telecare system for adults with developmental disabilities in Indiana: a multi-stakeholder perspective. Journal of Telemedicine and Telecare, 16, 265-269.

Taber-Doughty, T., Brewer, J. L., & Kubik, S. (2010). Standard care and telecare services: comparing the effectiveness of two service systems with consumers with intellectual disabilities. Journal of Intellectual Disability Research, 54, 843-859.

To find out more about participating in our Technology Project Focus Groups, contact us at Jordan.Wagner@osumc.edu or call: 614-688-3155

Technology Project resources


Remote Monitoring Fact sheet


News Articles

Columbus Dispatch Article about Remote Monitoring

Pipeline Quarterly 2014: DODD’s Newsletter about Remote monitoring


Videos

Originally for the 2008 Coleman Conference on Smart Home technology and personal support technology, this video, released before the iPad was introduced, is often cited as a positive vision for the way in which technology could be used to promote independence for individuals with developmental disabilities. While not all of the technology existed at the time, nearly all of it exists today. Here is a breakdown of the technology in the film and what some examples may be: http://www.ablelinktech.com.* 

If you would like to see what remote monitoring commonly looks, like here are some helpful videos. These three videos come from 4 different remote monitoring provider organizations*

*The Ohio State University Nisonger Center does not endorse any specific company or organization*

Technology Council

This project aims to examine the role technology, including remote monitoring, plays in the lives of people with developmental disabilities and their families, create a vision for how the use of technology may be improved and expanded upon within Ohio waiver services, and identify technological advances that might benefit people with developmental disabilities.

The mission of the Technology Council is to expand independence for people with developmental disabilities by using technology to facilitate independent living and self-reliance, including reducing the need for direct support professionals. The members of the Technology Council will have the opportunity to provide input and guidance to the members of this project team working on how to shape services to promote the use of technology to provide those opportunities for independence.



Technology Council May 9, 2017

Technology Project Frequently Asked Questions

 

How do I know if I’m eligible?
All Ohioans with a developmental disabilities waiver are eligible. The person’s support team should assess and discuss whether or not remote monitoring will meet the needs of the individual.
What are the duties of the remote support staff?
Remote monitoring is done in real time, not through a recording, by awake staff at another location. While remote support services are being provided, the remote support staff will not have other duties other than providing remote support services.
What happens if the power goes out?
The monitoring base is equipped with a backup power supply. In case this fails, direct-support staff will be notified and will respond accordingly. In the case of a power outage at the consumer’s residence, direct-support staff will be notified and will respond in a timely manner to ensure that the person is safe.
What happens if there is an emergency?
The provider of remote support services will notify first respondents. A direct support staff will also be contacted and respond accordingly. While the individual awaits emergency services, remote support staff will remain engaged with the individual until the first respondents and direct-support person arrive.
Who has access to shut down the equipment?
Remote monitoring equipment will be designed so that it can be turned off only by the authorized people and those specified in the Individual support Plan.          
How are people prevented from hacking into the live feeds?
The system uses a secure network system that requires authentications, authorization, and encryption of data to ensure that access to computer, video, audio, sensor, and communication is fully protected and access is limited to authorized persons only.

The following are questions that were generated for a session titled “Technology First and Remote Supports” held at the 2017 Spring OACB conference*:

 

What codes are used for billing backup support?

Paid Backup Support I/O AMR
 Level One FMR
Self-Empowered SMR
Unpaid Backup Support I/O AMS
Level One FMS
Self-Empowered SMS

                                                                                                                                                                                                                                

The remote monitoring equipment vendor is required to calculate the amount to be billed for remote monitoring equipment and to provide a monthly “lease” amount to be billed to the waiver.  This amount is the vendors’ cost to procure the equipment plus a setup and maintenance fee divided by the useful life (i.e. 36 months).  No other equipment costs are required and lump sum payments are permitted.

What codes are used for billing remote monitoring equipment?

Equipment codes/limits I/O  AML $5,000/Span (Equipment only)
Level One FML $7,500/3 years (Equipment & Service)
Self-Directed SML $25,000/Span (Equipment & Service)

 

Is it acceptable to authorize both HPC and remote monitoring for a short time to transition an individual/team/guardian into the new service?
HPC services and remote monitoring services cannot be billed at the same time. While an individual may use HPC services and remote monitoring at different times of day, they do not occur simultaneously. However, in a situation in which an individual has 2:1 staffing, remote monitoring may be used to reduce the ratio to 1:1 in addition to remote monitoring. Therefore, while there may only be one staff physically present within the home, the other staff is assisting from a distance.
What happens when the remote monitoring provider is responding to one individual while another individual requires assistance?
Multiple remote monitoring caregivers are available to respond to requests from any individual for whom services are being provided
Who is doing the monitoring?
Remote monitoring services are being provided by people who are familiar with the individuals ISP. In many cases, those providing services are Direct Support Professionals or have received the same training. Remote monitoring providers must fill out paperwork in the same way a direct support professional would. The rule specifically states: “Service documentation for remote monitoring shall include… [the] Description and details of the services delivered that directly relate to the services specified in the approved individual service plan as the services to be provided.”
What happens to the information?
While the rule does not guarantee recordings, it does say that IF recordings are made then they must be retained in the case of an UI or MUI. When there is not an MUI the recordings can be discarded.
How do you know they are not monitoring during other hours?
Remote monitoring equipment includes an indicator to the individual being monitored that the equipment is on and operating. The indicator shall be appropriate to meet the individual’s needs. Sometimes this is as simple as having a light on the device.
How long/where is the information stored?
In the case of an UI  or MUI, documentation is stored for seven years within a secure network system.
Who has access to the information?
The system uses a secure network system that requires authentications, authorization, and encryption of data to ensure that access to computer, video, audio, sensor, and communication is fully protected and access is limited to authorized persons only; those permitted by the ISP.
What kind of certification is required for providers?
Remote monitoring equipment shall be provided by an independent provider or an agency provider that has a medicaid provider agreement with the Ohio department of medicaid.
How are other counties providing actual backup staff if someone needs to actually go to the location? Are there provider agencies willing to be the “on-call” person or is it generally family or county board staff?
The rule leaves room for many options. If it is in the individuals best interest to have a family member provide the backup support, then that is a possibility. Alternatively, if it is in the individual best interest they ought to receive backup support from a HPC provider. Normally this is not an additional expense because the provider agency already has someone on-call.

 

 

…Update in progress…

 

*Answers based off of a presentation from Ken Smith and Dustin Wright*