Prevalence of Births and Interactions with Child Protective Services of Children Born to Mothers Diagnosed with an Intellectual and/or Developmental Disability.

OBJECTIVES: Concerns have been raised that parents with intellectual and/or developmental disabilities (IDD) interact with child protective services (CPS) at disproportionate rates than the general population as a result of bias and discrimination. However, there has been little empirical evidence to ascertain if these concerns are grounded. This study's objectives were to identify (a) the prevalence and sociodemographic characteristics of children born to mothers diagnosed with IDD diagnoses, (b) how many of these children interact with CPS (reports and removals) and (c) when these CPS interactions are occurring. METHODS: The dataset was comprised of linked administrative birth, hospital discharge, and CPS records for all children born in one U.S. state between 1999 and 2013 (N = 1,271,419). CPS records were available through the first quarter of 2018 and CPS reports and removals at the child's first and fourth birthdays were identified. We conducted chi-square tests and multivariate survival Cox regression models. RESULTS: A total of 567 children were identified as born to mothers with IDD diagnoses, which is 4.5 per 10,000 births. Of these children, 21.7% were the subject of a CPS report within 1 year and 35.8% within 4 years. In terms of removals, 6.5% experienced removals by 1 year and 8.6% by 4 years. CONCLUSIONS FOR PRACTICE: This study provides population-based knowledge about how and when the children born to mothers diagnosed with IDD interact with CPS. These children have higher rates of CPS interactions than the general population, but these rates are not as high as previously reported.

Perspectives on a mobile application that maps assistive technology resources in Africa.

BACKGROUND: Access to assistive technology (AT) is poor in African countries because of a lack of knowledge, resources, services and products. A mobile application (app), the AT-Info-Map, was developed to map AT availability in southern Africa. OBJECTIVES: This article aimed to describe users' and suppliers' perceptions of the AT-Info-Map app. METHOD: Qualitative data were collected in Zambia, Botswana, Malawi and Lesotho, through nine focus group discussions with 72 participants. Participants included AT users, AT suppliers and representatives of disability organisations. Data were thematically analysed. RESULTS: Two broad themes, that is, usefulness of the AT-Info-Map application and technical issues and content, emerged from the data analysis. Subthemes under usefulness focused on the importance of using current technology, convenience of the app, the need for accuracy, responsiveness of supplier to user's needs, influence on AT market and how the app creates an opportunity for networking. Challenges to download and navigate the app, the need for training in its use, exclusion of those not literate in English and those with visual impairments were subthemes under technical issues and content. CONCLUSION: The app was perceived as an important step to increase access to AT for persons with disabilities in less resourced settings. The challenges that emerged from the data analysis have led to the development of a web-based system that will complement or replace the app and improve AT information provision. However, the information provided by the app and website is still only a partial solution to improve AT access in Southern Africa.

Access to assistive technology in two Southern African countries.

BACKGROUND: Millions of people in Southern Africa are deprived of basic human rights such as the right to education and work because of the large and growing unmet demand for assistive technologies (AT). Evidence is needed to better characterize the lack of AT access. METHODS: This study serves to identify the sociodemographic factors that are associated with access to AT in two countries in Southern Africa, Botswana and Swaziland. To achieve this aim, logistics regression was applied to a subset of variables from two Living Conditions Studies, nationally representative surveys that were conducted in Southern Africa (2014 and 2010). RESULTS: In Botswana, 44% of people who needed AT did not receive it, while in Swaziland the unmet need was 67%. Among the sociodemographic variables tested, the type of disability was the most important factor in determining AT access in both countries. The likelihood of AT access was highest in both countries for those who had mobility limitations (i.e., difficulty walking/climbing stairs) [Botswana: 6.4 odds ratio (OR) = 6.4., 95% confidence internal (CI) (3.6-11.3); Swaziland: OR = 3.2, CI (1.4-7.3)], in comparison to those with non-mobility types of disabilities. CONCLUSIONS: These findings provide support for governments and other stakeholders in the AT sector to prioritize AT to address the large unmet demand, and expand the range of AT products provided so that people with hearing, seeing, self-care, communication and cognition difficulties have equal access to AT as those with mobility impairments. A step toward achieving these aims is to inventory AT product types that are commonly covered through the public sector in each country, and identify common gaps (e.g., daily living aids). Advancing the AT sector as a whole within Southern Africa will require large scale qualitative studies that achieve a comprehensive understanding of the bottlenecks in regional AT supply, procurement, and delivery systems.

Lessons from the pilot of a mobile application to map assistive technology suppliers in Africa.

A pilot project to develop and implement a mobile smartphone application (App) that tracks and maps assistive technology (AT) availability in southern Africa was launched in Botswana in 2016. The App was developed and tested through an iterative process. The concept of the App (AT-Info-Map) was well received by most stakeholders within the pilot country, and broader networks. Several technical and logistical obstacles were encountered. These included high data costs; difficulty in accessing AT information from the public healthcare sector, the largest supplier of AT; and the high human resource demand of collecting and keeping up-to-date device-level information within a complex and fragmented supply sector that spans private, public and civil society entities. The challenges were dealt with by keeping the data burden low and eliminating product-level tracking. The App design was expanded to include disability services, contextually specific AT categories and make navigation more intuitive. Long-term sustainability strategies like generating funding through advertisements on the App or supplier usage fees must be explored. Outreach and sensitisation programmes about both the App and AT in general must be intensified. The project team must continually strengthen partnerships with private and public stakeholders to ensure ongoing project engagement. The lessons learnt might be of value to others who wish to embark on initiatives in AT and/or implement Apps in health or disability in southern Africa and in low-resourced settings around the world.

Assistive technology in resource-limited environments: a scoping review.

PURPOSE: It is estimated that only 5-15% of people in low and middle income countries (LMICs) who need assistive technologies (AT) have access to them. This scoping review was conducted to provide a comprehensive picture of the current evidence base on AT within LMICs and other resource limited environments. METHOD: The scoping review involved locating evidence, extracting data, and summarizing characteristics of all included research publications. RESULTS: Of the 252 publications included, over 80% focused on types of AT that address mobility (45.2%) and vision (35.5%) needs, with AT types of spectacles and prosthetics comprising over 50% of all publications. Evidence on AT that addresses hearing, communication, and cognition is the most underrepresented within the existing evidence base. The vast majority of study designs are observational (63%). CONCLUSIONS: Evidence on AT in resource-limited environments is limited in quantity and quality, and not evenly distributed across types of AT. To advance this field, we recommend using appropriate evidence review approaches that allow for heterogeneous study designs, and developing a common language by creating a typology of AT research focus areas. Funders and researchers must commit much greater resources to the AT field to ameliorate the paucity of evidence available. Implications for Rehabilitation An increase in the quality and quantity of research is required in resource limited environments, where 80% of the global population of people with disabilities reside. Improved and increased evidence is needed to identify and understand needs, inform policy and practice, and assess progress made in increasing access to and availability of appropriate AT. Over 80% of the existing research publications on assistive technologies in resource limited environments address mobility and vision. More research is needed on AT that address hearing, communication and cognition. The use of a common language would facilitate the advancement of the global AT research field. Specifically there is a need for researchers to use a common definition of AT (i.e., ISO 9999) and typology of AT research focus areas.

Assistive technology access and service delivery in resource-limited environments: introduction to a special issue of Disability and Rehabilitation: Assistive Technology.

This special issue addresses access to and service delivery of assistive technology (AT) in resource-limited environments (RLEs). Access to AT is complicated not simply by limited funds to purchase AT, but by larger ecosystem weaknesses in RLEs related to legislation and policy, supply, distribution, human resources, consumer demand and accessible design. We present eight diverse articles that address various aspects of the AT ecosystem. These articles represent a wide range of AT, many different countries and different research methods. Our goal is to highlight a topic that has received scant research investigation and limited investment in international development efforts, and offer an insight into how different countries and programs are promoting access to AT. We encourage researchers, funders and non-profit organizations to invest additional effort and resources in this area.

Realizing the potential of accessible ICTs in developing countries.

PURPOSE: To raise the awareness of policy makers, economic development practitioners, and service providers about the importance of making information and communication technology (ICT) based international economic development in low- and middle-income countries inclusive of people with disabilities and to discuss the role and importance of addressing the complete ICT and assistive technology (AT) ecosystem to ensure sustainable, scalable, and affordable access to ICTs and ICT-based programs. METHOD: This commentary piece draws upon recent literature and practice cases to examine the role of accessible ICTs in international development. RESULTS: Accessible ICTs can enhance economic participation and prevent exclusion from participation in international development programs. Access to and use of accessible technologies are largely determined by the ecosystem in which they exist and can be enhanced or hindered by government policy and legislation and the quality of the service delivery systems and financing mechanisms. CONCLUSIONS: People with disabilities in developing countries face daunting barriers to socioeconomic participation. Accessible ICTs can eliminate or mitigate some of these barriers. However, technology advancements do not solely promote penetration, affordability, or scalability of ICT-based development for persons with disabilities. A comprehensive ecosystem approach can help in developing sustainable mechanisms for access, affordability, and availability.

Measuring pain in the context of homelessness.

PURPOSE: The primary objective of this study was to inform the development of measures of pain impact appropriate for all respondents, including homeless individuals, so that they can be used in clinical research and practice. The secondary objective was to increase understanding about the unique experience of homeless people with pain. METHODS: Seventeen homeless individuals with chronic health conditions (often associated with pain) participated in cognitive interviews to test the functioning of 56 pain measurement items and provided information about their experience living with and accessing treatment for pain. RESULTS: The most common problems identified with items were that they lacked clarity or were irrelevant in the context of homelessness. Items that were unclear, irrelevant and/or had other identified problems made it difficult for participants to respond. Participants also described multiple ways in which their pain was exacerbated by conditions of homelessness and identified barriers to accessing appropriate treatment. CONCLUSIONS: Results suggested that the majority of items were problematic for the homeless and require substantial modifications to make the pain impact bank relevant to this population. Additional recommendations include involving homeless in future item bank development, conducting research on the topic of pain and homelessness, and using cognitive interviewing in other types of health disparities research.