The International Journal of Psychosocial Rehabilitation

Investigating the Assistive Technology Skill and
Need for Knowledge of CPRPs



Lynn Gitlow, Ph.D., OTR/L, ATP
Program Director Occupational Therapy Department
Husson College
One College Circle
Bangor, ME 04401

Patricia Hofmaster, Ph.D.,
Director, Health Care Research
Eastern Maine Medical Center
Bangor, ME 04401

Jasemen Wade
MSOT Student
Husson College
Bangor, ME 04401



Citation:
Gitlow L., Hofmaster P., & Wade J. (2007). Investigating the Assistive Technology Skill and Need for
 Knowledge of CPRPs.    International Journal of Psychosocial Rehabilitation. 11 (2),  61-73





Abstract
Certified psychiatric rehabilitation practitioners (CPRP’s) work with people who have psychiatric disabilities to help them achieve their maximum functional potential.   Assistive technologies are “products that enable persons to perform a function that would otherwise be difficult due to some disability.”  Although there are many benefits to using assistive technology (AT), there are also many barriers preventing its use such as lack of knowledge.  Without knowledge of AT, CPRPs may   limit their client’s ability to access AT.    This study investigates the AT-related knowledge and skill that CPRPs have and need.  The findings have implications for developing educational programs.

Keywords: Psychiatric Rehabilitation practitioners, assistive technology  
 


Introduction
Certified psychiatric rehabilitation practitioners (CPRPs) are clinicians whose goal is to “enable individuals to compensate for the functional deficits, interpersonal barriers and environmental barriers created by the disability and to restore ability for independent living, socialization and effective life management” (Hughes, 2003). These practitioners work in a variety of settings such as hospitals, institutions, and mental health clinics, and work with a variety of people who have coexisting psychiatric disabilities, substance abuse and physical and social difficulties (USPRA) (formerly International Association of Psychosocial Rehabilitation Services (IAPSRS), 1997). Individuals with psychiatric disabilities may benefit from the use of assistive technology (AT) because these tools can help an individual compensate for problems with memory, sequencing, time management and organization among other things.

Assistive technology has been described as “products that enable persons to perform a function that would otherwise be difficult due to some disability.”  (US Dept of Commerce, 2005, pg 6). AT provided through computers, video cameras, e-mail reminders, and telephone can improve the performance for individuals of all ages with a psychiatric disability (NAMI, 2005). Other AT devices that may be useful for people with psychiatric disabilities include cuing devices, speech output devices, medication aides and safety devices such as GPS locator systems and anti-scalding devices (LoPresti, Mihailidis, &Kirsch, 2004; Cook and Hussey, 2002; Souma, Rickerson, & Burgstahler, 2001).

Although there are many benefits to using assistive technology, there are also many barriers impeding its use, such as funding, availability, quality of the device and lack of knowledge by health care and other service providers (Scherer, 2005; Edyburn 2004, Laki T, 2002).  Without knowledge of AT, CPRPs similar to other healthcare and service providers are more than likely limiting their client’s ability to access devices that could enhance their participation in meaningful activities and roles. 

A study by Gitlow and Sanford (2003) investigated the knowledge and skills regarding AT by healthcare professionals such as physicians, nurses, psychologists, physical therapists (PT), occupational therapists (OT), and speech language pathologists.  The study found that these practitioners did not have the knowledge and skill necessary to adequately provide AT related services to their clients.   Based on these findings and others reported in the literature, (PL 108-364, 2004; Healthy People 2010, 2000), we suspect a similar lack of knowledge regarding AT among CPRP’s. Therefore, the hypothesis of this study is CPRPs have a low level of knowledge and skill regarding AT.

Review of the Literature 
More than 45 million people in the United States have psychiatric disabilities that interfere with their ability to engage in day to day activities including going to school, working or daily living tasks (Jans, Stoddard and Kraus, 2004). The literature reports the “employment rate for people with a mental illness is much lower than the national employment rate and is especially low for people with more serious disorders” (Jans, Stoddard and Kraus, 2004, Section 2). The use of assistive technology and other accommodations in the workplace, such as flexible leave policies; computer support, adjusting work schedules, restructuring jobs, and modifying the environment can accommodate those with a psychiatric disability (Butterfield & Ramseur, 2004). 

Lower employment rates for people with psychiatric disabilities are also an international problem. For example, statistics provided by Crosse (2003) shows that 85% of those with psychiatric disabilities, such as schizophrenia, rely on welfare benefits, 72% do not have regular occupations, and 45% live in institutions, hostels, supported housing, crisis shelters, or are homeless. An American health interview survey provided by Healthy People 2010 states the use of assistive technology can aid an individual to become self sufficient, and enable someone with a disability to work, attend school, and participate in community life (Healthy People 2010, 2000).

People who have psychiatric disabilities also frequently experience cognitive disabilities. Of people with schizophrenia, 85% have a cognitive disability (Medalia & Ravheim, 2002). Cognitive disabilities can include difficulty in thinking clearly, paying attention, sequencing and memory. Verbal reasoning, problem solving skills, orientation, perceptual and analytic abilities, social reasoning and executive barriers are also difficult for those with psychiatric and/or cognitive disabilities (Medalia & Ravheim, 2002, Levine et al., 1992).  Assistive technology improves the day-to-day performance of people with such problems (Gentry, 2005; www.brainaid.com; Assistive Technology Partners, 2005).

Many psychiatric disabilities can be classified as a combination of more than one disability.  This is referred to as dual diagnosis.  The two most common dual diagnoses identified are mental illness and developmental disability and substance abuse (Pratt et al., 2002).  Assistive technology can be beneficial for people who have dual diagnoses along with those who have traumatic brain injury, schizophrenia, anxiety disorders, bipolar, depression, mood disorders, and OCD (Lopresti, Mihailidis, & Kirsh, 2004; Butterfield & Ramseur, 2004; McReynolds, 2002; Pratt et al. 2002).  
 
AT used by individuals with psychiatric disabilities includes a wide variety of devices ranging from low to high technology items. Low technological devices are inexpensive, easy to use, require little training, and may or may not have moving parts. Some examples of low technological devices include day planners, communication boards and lighted or print enlarging devices such as magnifying glasses. High technological devices have greater complexity and are also usually more expensive and contain an electrical component (Cook and Hussey, 2002).  Some examples of high technological AT devices are augmentative communication devices that allow individuals with psychiatric disabilities to communicate with others using synthetic or digitized speech programs, modified or alternative keyboards, or computer hardware and software for educational tasks (Hammel, 2003; Blake & Bodine, 2002; Parette, 1997; DeJorge, Rodger & Fitzgibbon, 2000).  One of the most frequently used devices in the workforce today is the personal computer.  Computers have many features that can help and people with and without disabilities (http://www.microsoft.com/enable/default.aspx and http://www.apple.com/accessibility/ ). There are also additional software programs to help individuals organize their thoughts, such concept mapping programs (www.smartdraw.com and www.inspiration.com ) as well as programs specifically designed to accommodate individuals who need assistance in order to complete their jobs and be effective workers such as the Planning & Execution/Assistant and Training System (PEAT), by Attention Control Systems (http://www.brainaid.com/ ) which is classified as a cognitive prosthetic (Butterfield & Ramseur, 2004; LoPresti et al. 2004). Another example of AT that has increased in popularity is the Personal Digital Assistant (PDA). This device can serve as a memory aide and task reminder for those with a disability related to memory as PDA’s feature a built in alarm system which is useful for daily planning and medication management (Sterns and Sterns, 2006; Gentry, 2005; LoPresti et al., 2004;Hammel, 2003; Blake & Bowdie, 2002).
CPRP's are positioned to have a significant impact on clients who could benefit from AT.  If CPRPs were aware of, and prepared to provide, AT related services, they may be better able to provide intervention to improve the well being of their clients and enable them to live more independent lives.

Methodology
The research design of this study is a quantitative, non-experimental, exploratory, descriptive design (Portney and Watkins, 2000). The Husson College IRB, because of minimal risk to participants, exempted the study from review.  A questionnaire was mailed to CPRPs. A mailing list of licensed CPRPs was obtained from an international organization formerly called IAPSRS (International Association of Psychosocial Rehabilitation Services), but today known as the United States Psychiatric Rehabilitation Association (USPRA). The inclusion criterion for this study was active certification as a CPRP. In order to obtain information regarding the knowledge and skills CPRPs have about AT, a questionnaire previously used for a study by Gitlow (2003) was adapted for this study. Reliability of the questionnaire was not insured in this study, although content validity was, as the questionnaire was pre-tested by AT professionals and CPRPs.
The questionnaire’s purpose was two fold.  First, to assess the current knowledge CPRPs perceive themselves as having, and secondly to assess what their perceived needs were regarding assistive technology. When questionnaires were received and compiled, statistics were used to summarize the data using the Statistical Package for Social Sciences (SPSS, 1999). A total of 430 questionnaires were mailed with a cover letter explaining the purpose of the study, and an assurance of confidentiality. A total of 117 usable questionnaires were returned for a response rate of 29%. The questionnaire is four pages in length and includes general demographic information questions and questions about perceived knowledge and need for knowledge about assistive technology. Prepaid preaddressed envelopes were provided and confidentiality of the respondents was assured.

Data Analysis:
Descriptive statistics were used to detail the demographic characteristics of respondents such as gender, education, profession, and work setting.  To understand the types of knowledge CPRPs perceive themselves as having about assistive technology, frequency distributions of the proportion of responses in each topical area were used.  In the questionnaire respondents were asked to rate their knowledge and need for information in each topic area as expert, basic or novice. In order to assess how much education is needed in each topical area, and how open the respondents are to learning about each area, the items were ranked from the highest to lowest percentages of perceived experts knowledge and need.

Results:
The majority of respondents (64%) were female and well educated.  Most respondents held master degrees (63%).  In terms of professions, close to half reported (41%) working as occupational therapists, administrators, or directors. Respondents also reported working as case managers, nurses, educators, and social workers. In terms of work setting, respondents were found to work in a variety of places.  The largest proportion (26%) worked in a community mental health center or in other mental health organizations (18%). See Table 1 for detailed findings.

Table 1: Characteristics of Respondents

Gender

N

Percentage

Female

74

64%

Male

41

36%

Education

 

 

High School Diploma

2

2%

Associates Degree

6

5%

Bachelors Degree

23

20%

Masters Degree

72

63%

Doctorate Degree

10

9%

Other

2

2%

Profession

 

 

Other

47

41%

Vocational Rehab

23

20%

Social Worker

19

17%

Case Manager

12

10%

Educator

10

9%

Nurse

3

3%

Physician

1

1%

Residential Worker

0

0%

Work Settings

 

 

Community Mental Health Center

29

26%

Other Mental Health Organization

20

18%

Other

17

15%

Government

11

10%

School/University

11

10%

Psychiatric Hospital

11

10%

Vocational Services

9

8%

Group Home

4

4%

General Hospital

2

2%

Nursing Home

0

0%

 

The questionnaire asked participants to rate their knowledge about specific topical areas regarding assistive technology and their need for knowledge in the same area.  Table 2 details the topical areas and percentages of respondents who rated their knowledge and need for information as expert, basic, or novice in each area.  For many of the areas, respondents have a basic level of knowledge concerning assistive technology.  Similarly, respondents felt they needed at least a basic level of understanding of the information in most areas.

Table 2: Levels of Current Perceived Knowledge and Information Needed

 

Current Perceived knowledge

Information Needed

Topical Areas

Expert

Basic

Novice

Expert

Basic

Novice

 

Technologies that improve ADLs

19%

(22)

64%

(74)

17%

(20)

22%

(24)

48%

(51)

30%

(32)

Technologies to improve communication

29%

(34)

52%

(60)

19%

(22)

27%

(29)

49%

(52)

24%

(26)

Technologies to improve independence in vocational activities

27%

(31)

56%

(65)

17%

(20)

38%

(41)

42%

(45)

19.6%

(21)

Technologies to improve independence in recreational activates

13%

(15)

62%

(72)

25%

(29)

17%

(18)

52%

(55)

31%

(33)

 

Technology to improve positioning

6%

(7)

43%

(50)

51%

(59)

18%

(19)

42%

(44)

41%

(43)

Technologies to decrease visual impairment

5%

(6)

36%

(42)

59%

(68)

13%

(14)

48%

(50)

39%

(41)

Technologies to decrease hearing impairment

7%

(8)

41%

(48)

52%

(60)

15%

(16)

48%

(51)

37%

(39)

Technologies to help with learning disabilities

14%

(16)

57%

(66)

29%

(34)

27%

(28)

51%

(53)

23%

(24)

Information on assistive technology needs

8%

(9)

37%

(42)

55%

(62)

19%

(19)

53%

(53)

29%

(29)

 

Information on sources of funding AT

7%

(9)

47%

(55)

45%

(52)

30%

(32)

47%

(50)

23%

(24)

Information on team membership collaboration in addressing AT

18%

(21)

57%

(66)

25%

(29)

27%

(29)

50%

(53)

17%

(25)

Information on funding appeals process

1%

(1)

28%

(32)

71%

(82)

20%

(21)

42%

(44)

38%

(40)

Information on teaching and learning self advocacy

45%

(51)

43%

(49)

12%

(13)

39%

(41)

45%

(47)

16%

(17)

Information on incorporating consumer perspectives into a final AT decision

 

27%

(31)

 

42%

(47)

 

31%

(35)

 

28%

(29)

 

45%

(46)

 

27%

(27)

Technologies to enhance functioning of memory problems

9%

(10)

42%

(48)

50%

(57)

29%

(30)

50%

(52)

22%

(23)

Technologies to enhance time management

20%

(23)

57%

(65)

24%

(27)

35%

(37)

48%

(50)

17%

(18)

Technologies to enhance self medication management

23%

(27)

52%

(60)

25%

(29)

40%

(42)

43%

(45)

18%

(19)

 

Table 3 presents the areas of knowledge in which respondents felt that they were experts.  These areas include teaching and learning self advocacy (45%), technologies that improve communication (27%) and technologies that improve independence in vocational activities (27%).  The areas respondents most frequently reported themselves having basic knowledge were technologies that improve ADLs (64%), technologies that help with learning disabilities (57%), and information in team membership collaboration in addressing AT (57%).  Refer to table 3 for more detailed findings.

Table 3: Knowledge of CPRPs

Expert Knowledge

Percentage

Basic Knowledge

Percentage

Teaching self advocacy

 

45%

 

Improve ADL’s

 

64%

Improve communication

 

29%

Learning disabilities technology

 

57%

Improve vocational activities

 

27%

Team membership collaboration in AT

 

57%



The five areas of perceived knowledge in which most respondents reported having only novice or lowest levels of knowledge included funding (71%), visual impairment (59%), and assistance in technology need (55%), deaf impairment (52%), and positioning (51%).  The areas in which respondents reported the greatest need for information were medication management (40%), teaching self advocacy (39%), improving vocational activities (38%), enhancing time management (35%), and funding devices (30%).  See table 4 for more details.

Table 4: Areas of Novice Level Perceived Knowledge and Need for Expert knowledge related to Assistive Technology

Knowledge

Information Needed

 

Funding appeals

 

71%

 

Medication management

 

40%

 

Visual impairment

 

59%

 

Teaching self advocacy

 

39%

 

Assistance on technology need

 

55%

 

Improve vocational Activities

 

38%

 

Deaf  impairment

 

52%

 

Enhance time management

 

35%

 

Positioning

 

51%

 

Funding devices

 

30%

 

In order to see if knowledge deficits and information needs differed by type of work setting, namely psychiatric and non psychiatric settings, responses were compared between the two groups.  Psychiatric settings included psychiatric hospitals, community mental health centers, and mental health organizations.  Non-psychiatric settings included school/university, vocational settings, government, group homes, nursing homes and “other”.  Table 5 lists the top five areas of knowledge deficits and information needed.  Similarities between the respondents in the two settings are apparent.  The top five areas of novice levels of knowledge include funding appeals in both psychiatric and non-psychiatric settings.  The remaining four areas include AT for visual impairments, assistance on technology need, AT for hearing impairment and positioning.

Table 5: Top Five Areas of Low Knowledge Base According To Work Setting

Psychiatric Setting

Non Psychiatric Setting

Area

Percentage

Area

Percentage

 

Funding appeals

 

81%

 

Funding appeals

 

64%

Visual impairment

 

61%

Visual impairment

 

57%

Assistance on technology need

 

57%

Assistance on technology need

 

56%

Deaf impairment

54%

Deaf impairment

50%

Positioning

54%

Positioning

50%

 

Turning to the results pertaining to information needed and what practitioners felt that they should have expert levels of knowledge were also very similar, but in a slightly different ranked order.  In the psychiatric setting the top areas of need for knowledge were medication management, improving vocational activities, enhancing time management, teaching self-advocacy, and enhancing memory. In a non- psychiatric setting the top five areas included teaching self advocacy, improving vocational activities, medication management, enhancing time management, and funding devices.  See table 6.

Table 6: Top Five Areas of Expert Information Needed By Work Setting

Psychiatric Setting

Non Psychiatric Setting

Area

Percentage

Area

Percentage

Medication management

44%

Teach self advocacy

37%

Improve vocational activities

41%

Improve vocational activities

33%

Enhance time management

40%

Medication management

32%

Teach self advocacy

39%

Enhance time management

30%

Enhance memory

37%

Funding devices

27%

 

Limitations:
Several limitations regarding this study should be noted.  Although the names and address of CPRPs were obtained form IAPSRS, many of the listings were not accurate and the response rate suffered as a result.  In addition, reminder postcards were not sent out.  Also, the response rate was probably adversely affected by the length of the survey, as it was four pages in length. The instructions on how to complete the survey could have also been clearer.  For example, several respondents selected more than one knowledge level for each topical area and some participants checked between boxes, or more than one box for each category.  A final limitation of the questionnaire was it did not include definitions for the categories expert, basic, and novice.

Discussion:        
Overall, there is a need for training and education regarding AT for CPRPs.  Less than thirty percent of the respondents regarded themselves as experts on AT in any one area except for the area of teaching and learning self-advocacy where 45 % reported being experts. This is not surprising given that one of the key underlying principles of psychosocial rehabilitation is empowerment (International Association of Psychosocial Rehabilitation Services, (n.d.). Interestingly, this was also an area respondents identified as an area where they needed to more knowledge. Again this is not surprising given the importance of this underlying principle of psychosocial rehabilitation.   Work setting does not show any particular significance to need and level of knowledge regarding AT among CPRP’s. Areas in which most respondents reported having only novice levels of knowledge such as funding, assistance in identifying AT need, AT for visual and hearing impairments and positioning make sense. Funding is one of the biggest challenges in getting AT to the people who can benefit from it (Public Law 108-364, 2004). Anyone who has ever tried to secure AT for those who need it are acutely aware of the ongoing need for knowledge in this area (O’day et. al, 2000). Another area of little knowledge identified by this group as well as others is how to identify the need for AT. Matching a person with the correct AT solution is critical to the success of AT intervention (Scherer et. al.,2005). This finding is consistent with the literature that confirms a lack of professionals trained in this area (Edyburn, 2004; Gitlow and Sanford, 2003). In regards to AT for those with a hearing or visual impairment, people who need AT for these disabilities may be seeing practitioners who specialize in these areas. It is interesting to note that in the state of Maine, CPRPs in community mental health settings are using the text messaging function of their cell phones to communicate with hearing impaired clients and staff (personal communication with John Painter, CPRP March 09, 2006). Finally AT for positioning is often considered for those who have physical disabilities. However, as the people with psychiatric disabilities live longer, this may be a consideration that becomes more relevant to those who work with this group.

The areas in which respondents reported needing the most education are related to technologies for medication management, vocational activities and time management, information about self advocacy, memory devices and funding approaches. Medication management in particular is an issue for this population. Many of the symptoms of psychiatric disability as well as the side effects of many medications used by those who have psychiatric disabilities impair memory and thinking abilities (Hughes and Weinstein, 2002; APA, 1994).  The literature reports that non-adherence and forgetting medication is one of the main reasons that people with mental illness become hospitalized and unable to carry out every day life tasks. (Personal communication with John Painter, CPRP March 10, 2006; Pies, 2002). As mentioned above, a number of studies have identified the value of AT devices for those who have memory and other cognitive problems, which can affect medication compliance (LoPresti, Mihailidis, &Kirsch, 2004; Wilson, Emslie, Quirk & Evans, 2001). Technologies to improve medication management include pill-dispensing watches, watches with alerts and timers, beepers, (www.epill.com)  and practical devices such as cell phones and PDA’s  that have multiple alarms for reminders. In addition to providing education about the technologies available to help with medication compliance, continued research studying the application of AT for medication management for this population is certainly needed (Department of Veterans Affairs, 2005-7; Cramer and Rosenback, 1998).
Given the importance of employment to health and well being and its stabilizing effect for person with mental illness ((Krupa, LaGarde & Carmichael, 2003; Tyrnssenaar, 2002; Marrone & Golowka, 1999) it is not surprising that CPRP’s have a need for more AT related knowledge in this area. It may be that once a practitioner has some awareness of the impact that AT can have on the performance of a client, they want to continue to keep abreast of the advances of AT as it relates to this area. Education in these areas can help CPRPs provide the right types of assistive technology solutions to help their clients attain their goals.

In helping educate people how to manage their time better, there are many resources which describe the use of planners, calendars and/or PDAs. http://www.biausa.org/Pages/AT/index.php?PHPSESSID=022658be412e2f1340a21f7a2b21c5e1).. AT that can help those people with their vocational activities include different computer programs such as ”Inspiration” which is a concept mapping program, lightened or enlarging devices such as magnifying glasses, wall calendar with clock, adaptive tools, and adaptive work environments and schedules (http://www.jan.wvu.edu/soar/index.html). To enhance memory, devices include cuing props, tape recorders, and text to speech systems. In the area of funding and self advocacy computer software as well as the Internet will give step by step instructions on ways to advocate for self, and how to fund for AT. The educational options are ongoing.
For future research, how to deliver educational programs to best meet the pre- service and continuing education needs of CPRPs will help us design programs that will be accessible to this group.

Conclusion:
CPRPs like many other practitioners who work with people who have disabling conditions, have the need for AT related education in order to meet the AT related needs of their clients. This study has given us some guidance on how to begin to prioritize that huge area of AT education to meet the needs of this group of practitioners. Much benefit could be derived from educating CPRPs about AT and providing training on funding and determining the need for AT and AT devices such as memory aides, medication management devices, time management planners, computer programs and other adaptations that can enhance a clients productivity.
 


References
American Psychiatric Association. (1994). DSM –IV Diagnostic and Statistical Manual of Mental Disorders Fourth Edition. Washington DC: American Psychiatric Association. .

Assistive Technology Partners. (2005). The RERC on Advancing Cognitive Technologies

Blake, D., Bodine, C. (2002).  “An overview of AT for persons with Multiple Sclerosis.”
Journal of Rehabilitation Research and Development, 39, (2) 299-312.

Butterfield, T., Ramseur, J. (2004).  “Research and case study findings in the area of workplace accommodations including provisions for AT: A literature review.” Technology and Disability, 16, 201-210.
CASRA (n.d.).  “What defines a PSR practitioner?”  Retrieved on 10-1-2005 athttp://www.casra.org/SocRehab/sr-defines.html

Cognitive Assistive Technology Expo Handout. RESNA Conference, June  21, 2004, Atlanta GA.

Cramer, J. and Rosenback, R. (1998). Compliance with medication regimes for mental and physical disorders. Psychiatric Services, 49, 196-201. Retrieved on 3/9/2006 at http://ps.psychiatryonline.org/cgi/content/full/49/1/196.

Cook, A., & Hussey, S. (2002). Assistive Technologies: Principles and Practice 2nd Edition. St. Louis: Mosby.

Crosse, C. (2003).  “A meaningful day: Integrating psychosocial rehabilitation into community treatment of schizophrenia.”  Medical Journal of Australia, 179, (9) Supplement 5 May: S76-S78.  Retrieved on 2/27/2005 at http://www.mja.com.au/public/issues/178_09_050503_cro10496_fm.html.

DeJorge, D., Rodger, S., Fitzgibbon, H. (2001).  “Putting technology to work: users’ perspective on integrating AT into the workplace.” Work 16, 77-89.
Department of Veterans Affairs (2005-7). Improving Antipsychotic Adherence Among Patients With Serious Mental Illness, Clinical Trial NCT00057135. Retrieved on-line March 13, 2006 at http://www.clinicaltrials.gov/ct/gui/show/NCT00057135;jsessionid=AA6DD5A142350B746E789704401C6A52?order=43.

Edyburn, D.L. (2004). Rethinking assistive technology. Special Education Technology Practice (5) 4,16-23.
Gentry,  (2005). A brain in the palm of your hand: assistive technology for cognition. OT Practice 10-12.

Gitlow, L, Sanford, T. (2003). “Assistive technology education needs of allied health practitioners in a rural state”.  Journal of Allied Health, 32, (1) 46-51.

Hammel, J. (2003).  “Technology and the environment: supportive resource or barrier for people with developmental disabilities?”  Nursing Clinics of North America, 38, 331-349.

Healthy People 2010, (2000). “Understanding and improving health: Disability and secondary Conditions.”  Retrieved on 3/20/2005 at http://www.healthypeople.gov/Docment/HTML/Vol1/06Disability.htm#_Toc486927299.

Hughes, R. Ph.D. (1993).  “Psychiatric rehabilitation is an essential health service for persons with serious and persistent mental illness.” Introduction to PsychiatricRehabilitation, 1993 PDF File.
Hughes, R., and Weinstein, D. (2000). Best Practices in Psychosocial Rehabilitation. Columbia, MD : IAPSRS.

International Association of Psychosocial Rehabilitation Services (IAPSRS) (1997). “Practice guidelines for the psychiatric rehabilitation of persons with severe and persistent mental illness in a managed care environment.” Retrieved on 4/4/2005 at http://www.uspra.org/pubs/downloads.html.

International Association of Psychosocial Rehabilitation Services (n.d.). Core Principles of Psychiatric Rehabilitation. Retrieved on 3/14/2006 at http://devuspra.i4a.com/i4a/pages/index.cfm?pageid=3376.

Jans, L., Stoddard, S. & Kraus, L. (2004). Chartbook on Mental Health and Disability in the United States. An InfoUse Report. Washington, D.C.: U.S. Department of Education, National Institute on Disability and Rehabilitation Research. Retrieved on –line March 13, 2006 at http://www.infouse.com/disabilitydata/mentalhealth/.

Laki, T. (2002).  “Use of AT in sheltered homes for persons with cognitive disabilities in Hungary-conclusion of a survey.” Technology and Disability, 14, 157-161.
Levine, S., Horstmann, H., Hirsch, N. (1992).  “Performance considerations for people with cognitive impairment in accessing assistive technologies.” Journal of Head Trauma Rehabilitation, 7, (3) 46-58.

Lopresti, E., Mihailidis, A., Kirsh, N. (2004). “AT for cognitive rehabilitation: state of the art.”  Neuropsychological Rehabilitation, 14,  5-39.

Marrone, J., & Golowka, E. (1999). Speaking out. If work makes people with mental illness sick, what do unemployment, poverty, and social isolation cause? Psychiatric Rehabilitation Journal, 23, 187-193.
 
McReynolds, C. Ph.D. (2002).  “Psychiatric rehabilitation: The need for a specialized approach.”  International Journal of Psychosocial Rehabilitation, 7, 61-69.

Medalia, A. Ph.D., Revheim, N, Ph.D. (2003).  “Dealing with cognitive dysfunction associated with psychiatric disorders:  A handbook for families and friends of individuals with psychiatric disorders.” Retrieved on 4/3/2005 at http://www.omh.state.ny.us/omhweb/cogdys_manual/CogDysHndbk.htm.

National Institute of Mental Health (NIMH) (2003). “The Numbers Count: Mental Disorders in America”: Publication No.  01-4584. Retrieved on 3/25/2005 at http://www.nimh.nih.gov/publicat/numbers.cfm.

NAMI (2005). “Presidents new freedom. Commission on mental health.”  Retrieved on 5/1/05 at http://www.nami.org/Content/NavigationMenu/Inform Yourself/About Public_Policy/ New_Freedom_Commission/Goal_6_Technology_Used_to_Access_Mental_Health_ Care.htm.

O’day, B., Brewer, J., Cook, D., Mendelsohn, S., Pierce, K., &Vanderheiden, G. (2000). “Federal policy barriers to assistive technology.”  National Council on Disability: Washington, DC [online]. Retrieved on 3-22-3005 at http://www.ncd.gov/newsroom/publications/assisttechnology.html.

Parette, H. (1997). “AT devices and services”.  Education andTraining in Mental Retardation and Developmental Disabilities, 32, (4) 267-281.

Pies, R. (2002). Alternatives for Non-Compliance. Retrieved on 3/14/2006 at http://www.mhsource.com/expert/exp1080502a.html.

Public Law 108-364, (2004). Assistive Technology Act of 2004.

Portney, L.G., & Watkins, M. (2000). Foundations of Clinical Research: Applications to Practice (2nd Edition). Prentice Hall: Upper Saddle Back, NJ.

Pratt, C., Gill, K., Barrett, N., Roberts, M. (2002). Psychiatric Rehabilitation. Academic Press: New York.

Scherer, M., Sax, C., Vanbiervleit, A., Cushman, L., & Scherer, J., (2005). Predictors of assistive technology use: The importance of personal and psychosocial factors. Disability and Rehabilitation, 27, 1321-1331.

Souma, A., Rickerson, N., & Burgstahler, S. (2001). Academic Accommodations for Students with Psychiatric Disabilities. Retrieved online October 29, 2006 at http://www.washington.edu/doit/Brochures/Academics/psych.html.

Sterns, A., & Sterns, H. (2006). Medication reminding for older adults using personal digital assistants. In W.C. Mann and A. Helal (Eds). Promoting Independence for Older Persons with Disabilities. IOS Press: Amsterdam.

Trynssenaar, J, 2002. Vocational exploration and employment and psychosocial disabilities. In F Stein and S. Cutler (Eds) Psychosocial Occupational Therapy: A Holistic Approach 2nd Edition. Delmar Publishing: Canada.

United States Department of Commerce (2005). Technology and innovation in an emerging senior /boomer marketplace. A paper prepared for discussion at the 2005 White House Conference on Aging by the Office of Technology, Policy Technology Administration.

United States Psychiatric Rehabilitation Association (USPRA) (2004). “USPRA welcome”.  Retrieved on 2/28/2005 at http://www.iapsrs.org/.

Wilson, B,A., Emslie, H.C., Quirk, K., & Evans, J.J.(2001). Reducing every memory and planning problems by means of a paging system: a randomized crossover study. Journal of Neurology, Neurosurgery and Psychiatry, 70, 477-482.




Copyright © 2007 Hampstead Psychological Associates, Ltd - A Subsidiary of Southern Development Group, SA.
All Rights Reserved.   A Private Non-Profit Agency for the good of all, published in the UK & Honduras