Web Posted on: February 24, 1998

Increasing Access Through Assistive Technology for People With Disabilites in Rural Areas

William M Bauer, M. S. Ed.
Director of Regional Centers
Ohio Technology Related Assistance Information Network
(Ohio TRAIN)
710 Colegate Drive
Marietta, Ohio 45750
(740)374-8716 ext 807
Fax (740) 376-9435

James G. Piazza
Program Coordinator
Ohio TRAIN Southeast Regional Center
710 Colgate, Ohio 45750

I. Introduction

People with disabilities often face traumatic consequences when trying to access assistive technology. Often times people with disabilities in rural areas face significant barriers when approaching local government and community organizations for services or funds for access to assistive technology. State and federal government agencies are obligated to include people with disabilities in their programs and functions. Depending on the various factors, accessibility' may be a figment of one's imagination. Assistive technology in the education process of the rural community increases the potential for persons with disabilities to succeed in independent living and to engage in productive employment, as well as enjoy what life has to offer to all.

Considering the variety of equipment and devices that are available, the field of assistive rehabilitative technology is rather broad and foreign to most people, especially to those who live and work in rural areas. Consumers, therapists, vendors, manufacturers, and advocates understand how assistive technology can make a difference in the life of a person with a disability.

However, sometimes 'key' people who are directly involved in the purchase or authorization of the assistive device doesn't understand why an item is needed or don't understand its implications on employment and educational opportunities. People with disabilities in rural areas have a sparse understanding of what assistive technology is and its applications are relatively unknown in most of America and more so in the rural parts of America.

Lack of awareness from media sources and education on the part of insurance companies, government agencies, educational institutions, and funding sources are usually the causes of denials for the funding of assistive technology devices. Many rural and underserved

communities have to look for alternative measures to access assistive technology devices as will be discussed further in this paper.

II. Statement of the Problem

People with disabilities in sparsely populated areas of the United States are often the 'victim' of many educational, funding and service barriers that presently exist while trying to gain access to assistive technology. Additional factors that influence assistive technology access in the rural community is geography, economy of the local region, history and tradition of the region and it's regional culture and it's traditions (Vitaliti, 1994).

The Technology-Related Assistance for Individuals with Disabilities Act of 1988 (P.L. 100-407) defines assistive technology as 'any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified or customized, that is used to increase, maintain, or improve...the functional capabilities of individuals with disabilities'.

III. Demographics

Approximately sixty-seven (67) million individuals reside in rural areas throughout the United States. This figure represents 27% of the total population of the United States and about 7 %, or 4 and a half million of all individuals, reside on forms. The rural population in concentrated mainly in the Midwest and the South. Nearly 44 million rural persons (71%) live in the South (43.4 percent) and Midwest (27.4 percent). Over half of the states (26) report a resident population of at least one million rural persons. Ohio ranked fourth with a rural population base of 2.8 million. Only Pennsylvania, North Carolina and New York have more of a rural population. (Census 1990).

Nearly 90 percent of the 1.2 million African- American children under the age of 19 live in rural counties in the South (Statistical Abstract of the United States, 1993). Rural areas can be defined according to RESNA (1994) as 'places of 2,500 or fewer inhabitants, with low population density in one or more large parts of extended cities and areas not classified as urban. Swaczy (1979) points out that the diversity of this population is best illustrated by understanding the 'economic factors, local history, social traditions, geography and proximity to urban centers that mold the character of different areas. Tenant farmers in the Southeast and a rancher in Montana have different outlooks. A coal miner in the Appalachian coal fields lives in a small town far different from the trailer in the town of a Wyoming coal miner'.

As we picture this scenario, we can see that rural means different things to different people. Bender (1985) classifies rural areas into seven economic ethnicity designations:

• Farming-dependent Counties-Farming contributes an annual average of 20 percent more of the total labor and proprietor income.
• Manufacturing -dependent Counties-Manufacturing contributed 30 percent or more of the total labor income.
• Mining-dependent Counties-Mining contributed 20 percent or more to total labor and proprietor income.
• Specialized Government Counties-Government contributed to 25 percent or more to total labor and proprietor income.
• Persistent Poverty Counties-Per capita family income in the county was in the lowest quintile.
• Federal land Counties-Federal land was 33 percent or more of the land area of the county.
• Destination Retirement Income Counties-Counties where the retirement income was 25 percent or more of the entire county income.

IV. Economic and Employment Status

According to Bender (1985), the economy of rural areas is often times shaped into a single industry and employment opportunities are severely limited when the economy threatens the largest employer of the area. This has a devastating effect to young adults and minorities with disabilities in the rural areas.. Fitchen (1981) has identified 10 causes of rural poverty that are evenly divided into primary and derivative forces. The primary causes are the political economic forces such as: 1) the continuing impact of history; 2) the crippling economic situation; 3) inaduencies of the social structure; 4) barriers to upward mobility; and 5) the corrosive stereotypes. The author believes all of these factors play a role or barrier for people with disabilities accessing assistive technology other than the common attitudinal and architectural barriers.

The Department of Commerce (1993) indicated that the high levels of poverty in rural areas are associated with infant mortality, illiteracy, unemployment and poor housing conditions.

Specifically in Ohio, unemployment rates dropped except for Appalachia and unemployment rates dropped in Ohio except for the disability populations since 1994 (1997 United Way Scan). Appalachia Ohio has the highest infant mortality rate of the four regions according to the United Way Scan (1997). The Ohio Department of Health (1994) indicates that the highest infant mortality rates are found mainly in the Appalachian counties. Ohio's county with the highest mortality rates are found mainly in the Appalachian counties. Ohio's county with the highest mortality rate is Morgan County with a rate of 20.7 infant deaths per 1,000 live births.

V. Cultural Influences

Several cultural elements affect people with disabilities in rural areas. Such elements include: transportation, geography, community structure, medical health, family involvement.

Climate and road restrictions and conditions may restrict access to services. Transportation services may have high costs or may be unavailable. Poor or non-existent transportation services or lack of interagency agreements and collaboration or may be wheelchair non-accessible (Revis and Revis, 1978). Long distances from services and inadequate barriers to housing to meet the geographical needs of people with disabilities. Communities show a sense of resistance to change when thinking of alternative ways to assist people with disabilities and their needs. Communication doesn't usually occur between groups but rather people to people. Davis and

Marshall (1975) stated that because of the severe shortage of health personnel, it explains why health occupations will account for one is six new jobs in Ohio. People are living longer and infants with disabilities that would have died ten years ago, are now living (Ohio Dept. Of Health 1988). Families must be involved in the delivery of services to create partnerships and rural communities often require a lengthier period of time and involvement.

The ability to participate in societal events is very low for a person with a disability, especially in the rural areas. Twenty-five percent of rural people with disabilities have a higher rate of serious functional limitations (USDHHS, 1980).

Leland (1982) cited that individuals with disabilities are overly represented in rural and sparsely populated areas. He says that rural people with disabilities are more disadvantaged than their urban counterparts and tend to be less educated, and have fewer job opportunities. A Marietta Times (1997) article indicated that Ohio tracked close to the national average of 24.5 percent of 2 million people have some disability. Counties in Appalachia Ohio had much higher percentages.

The report from The Times estimated that 12.89 percent of Ohioans fell into the category of severely disabled. The estimates derived from a current Census report indicated that percentages of people with disabilities in Appalachia Ohio are: Monroe County, 3,694, 31.10 percent; Morgan County, 3,181, 30.57 percent; Noble County, 2,377, 28.62 percent; Washington 12,733, 26.71 percent.

VI. Barriers to Delivering Services of Assistive Technology in Rural Areas.

In an article from Specialink (1990), they offer a variety of reasons for the inaccessibility of assistive technology in the rural areas. Such obstacles include lack of funding, consumer and service provider differences, transportation, unqualified personnel, governmental regulations and politics, lack of knowledge of assistive technology equipment and geographical location or community acceptance.

Vitalititi (1997) states that rural consumers have specialized needs such as transportation, available health care, barrier free places of shopping, and access to peers and family. Influences from the rural region may exist that influence a consumer's acceptance of the use of technology or involvement of service personnel in their lives. Greenlee (1991) studied the culture of

Appalachia Ohio families with disabilities and found that people who live in rural environments choose to do so because they didn't know where to go. Some people complained about the highcosts of moving and others believed that wages wouldn't pay for the high cost of living. Also, people with disabilities wouldn't have to mess with the fast paced life in the big cities. The primary reason that people don't leave the rural communities appears to be revolving around family and community conceptualization. Some believe that resources are inadequate no matter where they live.

VII. Current Available Services

Currently, the Federal Tech Act of 1988 offers assistance in all 50 states as well as Puerto Rico, American Somoa, Guam and the Virgin Islands. The mission of the Tech Act as well as Ohio's Tech Act Project (Ohio TRAIN) is to collaborate with persons with Disabilites and others to initiate systems change activities through consumer driven, advocacy based, comprehensive statewide programs which increase the availability and utilizations of assistive technology devices and services. Ohio TRAIN believes that several variables such as ruralty, poverty, unemployment, low-income and cultural diversity, constitute formidable roadblocks to obtaining assistive technology for people with disabilities.

Among the many private associations giving their technical expertise on assistive technology to rural people with disabilities, RESNA (Rehabilitation Engineering and Assistive Technology Society of North America) has been successful in competing for Federal funds to conduct specific programs and projects related to assistive technology. A most notable achievement was receiving an award in 1989 of a three year, $1.5 million contract from the federal government to provide technical assistance to all of the State Tech Act Projects in the areas of service delivery, funding and systems change. In 1992 and 1995, RESNA won additional support for this program. Many of these states offer specific services for their rural populations.

Ohio TRAIN has specific objectives that relate to the Federal and State Mission:

• Increase the availability of assistive technology access and funding.
• Provide services to underserved individuals and groups in rural areas.
• Promote coordination between state and private agencies.
• Increase awareness of laws, regulations, policies, practices and processes and assess these when they restrict access to assistive technology.
• Enhance the skills of technology providers and users.
• Increase active involvement and awareness among people with disabilities employers, educators, technology experts, and other appropriate people.
• Increase the capacity of public and private agencies to provide and purchase assistive technology devices and services.

Currently, Ohio TRAIN is planning to expand its traditional service delivery program to develop a new and creative non-traditional service delivery system and approaches. In an effort to reach its rural and underserved populations, Ohio TRAIN is now decentralizing its operations to met the unique needs of its rural consumers. In addition to its Columbus office, Ohio TRAIN now has Rural Resource Centers in Marietta (Southeast) at Washington State Community College, Toledo (Northwest),and Cincinnati (Southwest). Ohio TRAIN hopes to open a resource center in Youngstown (Northeast) during 1998. All centers are in an effort to reduce barriers to allow consumers with disabilities to access assistive technology and find out what the service gaps are in each area.

VIII. Recommendations

The rehabilitation professional must design a service or program delivery system that takes into account the rural consumer with disabilities distance to service, geographic barriers, cultural diversity, population sparsity and its own community flair. A collaborative effort within communities can be accomplished by a consortium of key players including business leaders,

consumers with disabilities, professionals, parents and friends. This coalition of people can assess the needs of assistive technology and services for its area for its consumer young and old. Rehabilitation service providers must be able to keep up on the current trends and issues facing it's community by recognizing what services are presently available so that duplication of services doesn't exist; develop a sense of attitude and expertise of the communities by implementing coalition meetings and facilitate and develop forums that will allow all consumers with disabilities a chance to speak about issues and concerns regarding access to assistive technology. The rural rehabilitation professional will have to be flexible in his or her approaches and will require a tremendous amount of creativity to all a system to work or change.

Strategies may also include offering a mobile technology program to simulate assistive technology in the home or workplace. Education programs on assistive technology devices as well as diversity and cultural awareness need to be implemented. Include these programs in higher education programs that require teachers to take before becoming certified. Teacher who are trained in diversity and cultural awareness as well assistive technology may be more apt to invite a child with a disability in his or her classroom. This would reduce the stigma that teachers fear of children with disabilities and their 'devices'.

IX. Conclusion

Rural communities that have people with disabilities (and we all do) must grasp the concept of 'customer satisfaction'. The author believes that each rural community is unique and different.

No rural community is just like another. Services and changing of systems must reflect the unique wants and needs of the person with a disability (customer). Procedures and policies must be put in place that allows the consumer to address and express those needs and identify the barriers that help or hinder the service or system in rural communication. The rehabilitation professional must know the community in which the 'customer lives, works or plays and strive to provide new, creative and although challenging avenues in ways to provide access to people with disabilities and assistive technology in rural America.

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