A good advertisement is fundamental for ensuring proper understanding of the subject and objectives of the course, for attracting the intended audience, and for shaping the attitude of people towards the course. In today’s image society, the choice of medium, the messages delivered and the quality of presentation play a paramount role in getting the educational initiative understood and making it stand out in the flood of messages that we all receive every day.

The EUSTAT survey highlighted that most organisations involved in educational initiatives place great importance on advertising. They often maintain address databases of potentially interested persons and organisations, or even send periodical newsletters to them. They also devote great effort to spreading information through word of mouth or leaflets handed out at the congresses or exhibitions that interested people are expected to attend.

The most traditional (and sometimes still winning) method is the leaflet or pamphlet. This provides precisely and exhaustively all the information needed, is suitable for handing out or mailing to people, and can be attractively designed to increase appeal. Printing and mailing costs are often very high, depending on the desired print quality and weight of paper used. Powerful desktop publishing software is now available on personal computers, allowing virtually anybody to prepare high-quality leaflets and thus avoiding the costly process of professional typesetting. Nevertheless, the difference between a professional leaflet and a home-made one is still evident.

Specialised journals such as user organisation magazines, topical journals addressing a specific area and the like are often a good place to publicise a course. Many journals do not even charge for advertisements since they consider such information attractive to readers and thus prefer to have a full article reporting the course in detail. Most journals of this kind are not published very frequently, so it is important to get agreement well in advance to ensure that readers find the news when there is still time to decide to participate.

Newspapers are published more frequently and reach a wider audience, but the advertisement may be buried in the bulk of news and thus overlooked. It is not easy to ensure that information is published accurately, as journalists often have to take account of space restrictions or appeal requirements. Paid advertising certainly avoids this risk but is very expensive.

Needless to say, radio and, to a greater extent, television have a tremendous potential impact. The effect on the audience depends on transmission time, the format of the programme, the effectiveness of the message, and the ability of those who deliver it. Since television evokes emotional viewing, it is important to remember that a number of secondary messages are always delivered, consciously or otherwise, along with the main intentional message, and these can have both positive and negative effects. Such aspects should be carefully controlled: there is a risk of being misunderstood, giving conflicting cultural messages, and receiving thousands of calls from people who are not really interested.

The Internet is taking an increasingly prominent role in this field. Information can be easily and quickly spread at virtually no cost to anyone anywhere in the world who has access to electronic mail, discussion or news groups, or the World Wide Web. The problem is message visibility within the network, a factor that greatly depends on the prominence of the web site and on how well its descriptive language has been written so that the site is picked up by search engines.

The choice of advertising channel depends on the target to be reached. Some media, such as placards posted on walls in certain areas of town, are well suited to a wide and generic target, while others like announcements in category journals may be preferable when the target is specific. Even in mass media such as TV, the outreach may be differentiated through proper placement within the schedule: scientific programmes attract a focused and restricted audience, while so-called magazine programmes reach a wide and generic target. The type of organisation carrying out the educational initiative may also be a contributing factor: if the organisation has a reputation in the scientific community, information about its initiatives will be expected to appear in scientific journals; if it is an end-users’ organisation, people may expect to be informed through local channels such as radio and TV, placards and leaflets.

The presentation style is an important matter. Messages should be concise, consistent with the type of initiative, contain all the essential information, and carefully checked before delivery. Another critical aspect is timing. Potential candidates should receive the information neither too earlier (since everybody tends to forget), nor too late with respect to the key deadline. Those who have no previous experience of advertising tend to underestimate the time needed to get a leaflet designed, drafted, proof-read, printed, mailed out and delivered. A good advertising plan generally makes use of different media to "dose" the message at different times.

The following scheme offers a brief summary of the above concepts.

Medium: leaflets, pamphlets

Target:

• wide
• both generic (congresses, etc) and well-defined (personal mailing)

Advantages:

• precise, exhaustive information
• suitable for handling and mailing
• may be attractive

Disadvantages:

• high printing and mailing costs, depending on desired quality and paper weight

Medium: specialised journal

Target:

• well-defined and specialised

Advantages:

• reaches a well-known audience
• information may be very detailed and exhaustive

Disadvantages:

• requires agreements with the editors well in advance
• does not reach beyond an "inner circle" of people

Medium: newspaper

Target:

• wide, generic

Advantages:

• also reaches interested people not yet known to the organisation

Disadvantages:

• announcement may be buried in the page
• difficulty controlling accuracy of printed information
• expensive if paid advertisement

Medium: radio and television

Target:

• wide, generic, depending on programme time and format

Advantages:

• strong impact on the audience

Disadvantages:

• requires ability in delivery contents through the specific medium, so as to avoid misunderstandings

Medium: Internet

Target:

• well-defined within discussion and news groups
• unpredictable if on the World Wide Web

Advantages:

• quickness and ease in spreading information
• very low cost
• worldwide outreach

Disadvantages:

• the message may be barely visible on the web
• not yet a mass-medium in some countries

When it is paramount to maximise participation in order to "spread the message" as widely as possible, and there is no constraint on the number of attendants, the best option may be open admission, meaning that everybody is welcome. In this case, the organisers must be prepared to deal with a broad range of expectations and motivation, or even with people who did not clearly understand the subject. This last problem can be avoided by clear and precise advertising. On-site collection of information about participants (e.g. a questionnaire enclosed in the enrolment form) may help adjust to the audience to a certain extent.

When the educational initiative is designed for a specific target with well-defined learning objectives, some kind of selection is important: one possible option is attendance by invitation. This is possible when the organiser knows who will meet the requirements. It must also be made clear that this option gives little opportunity to people who might in principle be suitable candidates, but who are outside the "inner circle".

An intermediate solution is to advertise the course at large, and establish self-explanatory selection criteria (age, educational level, etc) that permit simple verification of eligibility; this can be done through a self-completed form, an interview, or certificates. Such an approach may be an efficient compromise between the need to control the consistency of the group and the need to limit organisational effort in the selection process. However, eligibility criteria alone may not be sufficient to ensure that the group is really consistent.

The safest method may be an individual interview, possibly following a verification of eligibility. This allows better insight into the trainee’s background and motivation, helps to identify possible problems in advance, and starts a personal relationship with each trainee. Instead of an "interview" in the strict sense, an "introductory chat" may be held, the difference being the more informal level of evaluation. In any case, an interview entails organisational demands and requires competent people to carry out the delicate task of evaluating candidates.

The actual organisation of the course requires that both the pedagogical factors and the purely organisational/management factors be addressed. Pedagogical factors will be discussed later. The scheme below describes the factors that will be analysed.

Organisational factors:

• Venue
• residential
• on centre
• on site (itinerant)
• domicile
• Physical environment
• accessibility
• technical facilities
• personal assistance on site
• comfort
• resting facilities
• aesthetics
• Related social activities
• assistance with travel/accommodation
• meals/refreshments
• cultural/recreational events
• welcome/farewell sessions
• Financial scheme
• free of charge
• fee contributing partially to costs
• fee fully covering costs
• scholarships

The choice of venue has a great impact on both the effectiveness and the outreach of the course.

A residential course facilitates personal relationships among participants, but requires people to travel and this may be expensive. Nevertheless, holding a residential course is sometimes the only possible solution when participants come from remote places.

A simpler form of course from the organisational viewpoint is one held on centre, in other words on the organiser’s premises or at a purposely-hired centre, with sessions scheduled in working hours so that trainees can go back home or to their hotel.

Itinerant courses held on site in the various communities where users live avoid people having to travel, take work leave or make complex arrangements for personal assistance. However, they may be complex to organise, and trainees miss the opportunity to meet peers from different environments or cultures and exchange views with them.

The ultimate form of de-localisation is the domicile course, where trainees receive education in their own environment. Training may be individualised, extended to members of the family or primary work, or even extended to peers (e.g. in community homes).

There may also be mixed solutions where the educational curriculum comprises a number of modules, each held at a different venue (e.g. a set of on-centre seminars followed by a week-long residential course that is rounded off with a follow-up domicile session).

The quality of the physical environment in which the course takes place is very important for the quality of listening and participation.

The main prerequisite is accessibility with respect to the participants’ disabilities, which not only means the absence of stairs but also accessible bathrooms, furniture, etc. Physical comfort is another important environmental attribute that can help maintain attention levels and avoid undue tiredness: it can be obtained through careful attention to seating arrangements, acoustics (damping background noise and echo), lighting and air conditioning.

The educational material and teaching style may call for technical facilities like a p.a. (amplifying) system, headsets for simultaneous translation, acoustic loops, overhead and slide projector, flip charts, videotape reader, computers, video-conferencing, video-projector, etc. It is important for testing to be done before the course starts, and that somebody should be appointed to operate or supervise the use of equipment during the sessions. When an educational session relies on electronic equipment, a technical breakdown may result in the total failure of the session.

Other aspects to be addressed are personal assistance on site (so as to allow people with severe disabilities to take part in discussion, change position or go to the bathroom when needed) and the availability of resting facilities, the best solution in a residential course being when personal rooms and work rooms are in the same building.

Last but not least of the factors deserving consideration is the aesthetics of the site. A teaching room cluttered with material or information (e.g. with an excessive number of wall posters that distract attention) or painted in brash colours may not be an ideal learning setting. The environment is not only a technical space, but also an expression that evokes feelings of acceptance, closeness, interest and appreciation.

These may be important for facilitating participation, fostering relationships with fellow trainees and trainers, and creating a climate of comfort.

Accessibility of premises and public transportation may pose a major problem for people with motor disabilities. Uncertainty as to whether assistance is provided when getting off the train, or whether the room and bathroom are really accessible with respect to one’s particular needs may discourage participation. So assistance with travel and accommodation is more than welcome.

Meals and refreshments on site avoid people wasting time to go out during the breaks. People with motor disabilities often have to dedicate more time and effort than others to get from one place to another. If a proper setting is provided, meals and refreshment breaks can be used as a valuable opportunity to promote relationships and informal exchange.

Cultural or recreational events may be held for relaxation, but also to create a warmer atmosphere; they may also be a useful opportunity for trainees and organisers to get together, and even to mix with the local community where the course is taking place.

A welcome session helps to break the ice between the participant and his/her often unknown peers, and is also the opportunity to give practical announcements for the start of the course. A farewell session fosters reflection and discussion among participants about the results achieved, helps to instil lasting positive attitudes towards the experience, and sets the ground for further contacts.

The way costs are covered has a great impact on the quality of the course and on participation.

If sufficient funding is available from one source or another, the free-of-charge scheme is certainly the one that offers the best opportunity for anybody to participate. However, it should be remembered that even free events may entail travel and personal assistance expenses that hamper would-be participants with financial problems; in this sense, the experience is not really "free-of-charge" at all.

When external funding sources are available that do not cover all costs, a reduced fee ("token fee") may be applied to cover the balance. Some organisers even prefer to apply a token fee as matter of policy, since dropout rates and motivation failure are higher among those attending free-of-charge than among those who incur costs.

The alternative is to apply a fee that fully covers costs (or even makes a profit, if compatible with the organiser’s nature). This has the advantage of totally freeing the course of external sources and related constraints, but the fee may be so high that only a small "elite" can afford it. A sensible solution is to offer scholarships that partially or wholly cover the winners’ fees; this entails establishing eligibility criteria, and poses organisational demands for application assessment.

There are at least three other aspects that have important organisational consequences: information collection from participants, the opening session and teacher co-ordination.

Whatever the participant selection procedure, it is always a good idea to organise some information collection on participants. A registration form may be the easiest method; questions related to cultural background, profession, age, provenance etc. can be asked at this stage, provided that this is done in compliance with existing laws regulating the protection of privacy. In some cases, it may also be a good idea to administer an introductory questionnaire or conduct an interview. This can be done to collect data on the participants’ expectations, on their pre-course knowledge about the scheduled topics, and on whatever else is considered important for matching the contents and didactical methods with the characteristics of the trainees. After the educational initiative is finished, this data can be filed away or stored in the organisation’s database to be used for later initiatives.

Even in cases where a specific welcome session is not planned, attention should nonetheless be devoted to the opening session, the first plenary occasion when participants meet each other. Starting off on the right foot makes trainees and trainers feel comfortable, and establishes the right atmosphere. The opening session may be used to foster reciprocal knowledge by means of a self-introduction, or such like. However, some caution is needed: there may be people who feel embarrassed when speaking in public, or participants whose verbal expression is impaired, thus requiring communication aids or just more time or effort to express themselves. It is up to the moderator to quickly evaluate the situation, decide how to facilitate, and intervene when necessary. Good ice breaking helps to establish an effective learning community.

Although teacher co-ordination is mainly a pedagogical issue (and will thus be discussed later), it is important that such co-ordination be made apparent to trainees. It calls for consistency between contents and educational style in order to avoid repetitiveness, contradictions and no-man’s-lands; it also helps to construct successful relationships among teachers so that they are seen to be working in full co-operation.

One way of achieving this objective is to gather the teachers together in a working group so that a common educational methodology is developed. Ideally, the group should meet regularly during the course, as well as during the lead up and in the aftermath. This is the strategy adopted by Centro Studi Prisma (Italy), to take one example. Their teachers stay together (and with the trainees) during the residential courses, attend each other’s lessons whenever possible, and have regular progress meetings to check the trainees’ learning, adjust the course to possible unexpected events, and evaluate effectiveness. Such measures help to improve quality remarkably, but also entail considerable human and financial costs.

The EUSTAT survey found that most organisations carrying out educational initiatives expressed great interest in the evaluation stage, but seldom used systematic evaluation instruments. Feedback from the audience was mainly collected in an informal way, through discussions devoted to the exchange of personal impressions, or even private conversations. However, this method may not provide a complete picture of the initiative’s success: there are other methods that provide a better understanding both of participant satisfaction (evaluating success) and long-term effects (evaluating outcome).

Several survey methodologies are available for analysing participant satisfaction, revealing what aspects the participants liked, what they would change, and what they deem to have learned. These methods are summarised in the scheme below.

Type of educational activity: courses (especially residential), series of seminars

Advantages: consolidated methodology, possibility of quantitative analysis, reliable (anonymity), allows comparison with the introductory questionnaire if applicable

Disadvantages: demands of designing the questionnaire and analysing data, whole process takes considerable time, open-ended questions are difficult to analyse, multiple choice questions may fail to gauge participants’ real opinions

Recommendations: avoid open-ended questions if the group is large

From the organisers’ perspective, the participants’ judgements - along with self-evaluation - are also useful for identifying mistakes that may have been made at any stage. Reflecting about these helps when seeking to identify possible remedial actions or improvements to implement in further editions of the same educational initiative.

In the field of education, outcome evaluation is currently considered of fundamental importance, but still represents a major challenge: no final consensus has yet been reached on the focus of evaluation, on timing, or on the instruments to be used. However, in specific areas such as AT education it is somewhat easier to identify at least two appropriate outcome indicators:

Were the learning objectives achieved?

Did the knowledge learned activate real, positive changes towards empowerment in the participants’ lives?

The first aspect - learning new knowledge - can be evaluated through forms or questionnaires administered in the aftermath of the educational event. This evaluation is obviously paramount for educational initiatives that issue certificates, which in some cases may even require an examination in the true sense. Sometimes this evaluation is also important from the perspective of the participants’ sender. For example, a person with disability paying for his/her personal assistant’s education may be interested in finding out the training’s effectiveness. In this case, the evaluation might even be carried out by personally contacting the sender and asking him/her to fill in a form or provide a report stating whether the learning was consistent with the educational needs.

The second aspect - How did the learning contribute to empowerment? – is particularly interesting but difficult to investigate. Empowerment is a process of personal growth and re-appropriation, so it can only be experienced and appreciated by the person him/herself.

Some suggestions...

The most suitable instruments in this case are survey methodologies based on personal contact, such as interviews and conversation with the involved persons.

Interviewers should be careful to avoid giving any hints about the aspects of change they are most interested in.

Numerous didactical methodologies can be used in education, and these may be identified with different terms in different countries. The methodologies that apply to AT education are described below.

Theoretical and procedural knowledge are mainly acquired through symbolic means such as lectures, while practical knowledge and know-how may require the concrete manipulation of objects and reproduction & experimentation or trial & error experiences. To provide the full picture, so-called knowledge of being should also be considered: this relates to the individual’s inner dimensions and underpins the other forms of knowledge by giving them personal meaning.

Two examples may help to clarify this concept

John....

is a person with disabilities, who has been driving a wheelchair for more than twenty years. So he has certainly some "hand skills" and "effective tricks" by which he manages to obtain a satisfactory level of comfort: this is his know-how. However, John also has available some procedural knowledge: instruction for use of the wheelchair supplied by the manufacturer, technical handbooks, safety warnings etc., but he does not have necessarily the theoretical knowledge to deal with technicalities: understanding the working of the batteries, the electronic control, the motor etc.

Charles...

is a technician; he knows the engineering aspects of wheelchairs, so he has the theoretical knowledge. He also knows John’s practical requirements related to the wheelchair and his special needs, so he has practical knowledge too. Finally, he has procedural knowledge available (technical manual, standard procedure in case of failures etc.).

A person can be knowledgeable about a subject without necessarily managing all four types of knowledge. Nevertheless, any action of knowledge transfer to the end-user should embrace the above dimensions and try to integrate them effectively.

The teaching style greatly depends on the individual teacher’s qualities and previous experience.

The presentation of a lecture can be defined as well structured when its contents are developed following a logical path that is clear to the learners. Graphical schemes may be used to help listeners keep the path in mind and memorise contents. Plain but engaging language is recommended. Evocative, exemplifying, sometimes ironical speaking may be useful, however these attitudes should always be tuned to the participants’ socio-cultural background. Educational instruments and material can help to brighten up the lesson.

Remember...

The success of the lesson might be determined by other aspects such as the speaker’s tone of voice, wealth of the verbal expressions, body postures, gestures and facial expressions. How many teachers do we remember because of the boredom they provoked with their flat tone? How many failures at school did we ascribe to a bad human relationship with the teacher?

An atmosphere of interactivity and co-operation within the learning group may make the lecture livelier, and favour concentration and listening. Teachers who make extensive use of questioning, for instance, establish great interactivity: they challenge participants with questions, listen to their opinions, and promote interpersonal exchange. By putting the right questions, they help listeners to recall notions and open their minds to new information.

For example...

Before presenting a lesson on augmentative communication aids, the teacher may ask the trainees to make a list of all the aids they already know, use or have seen used. The list will be a common basis for the lesson; it may contain gaps, mistakes or imprecision that reveal to the teacher the quality and type of the learners’ knowledge. The lesson will then confirm the right notions and disconfirm the wrong ones. The participants will be able to store knowledge easily in their memory.

Whereas questioning aims to involve each and every listener, discussion aims at more generic involvement, everyone being free to contribute or not. The focus of the discussion usually follows the flow of the debate.

Remember...

A discussion might become captivating, especially if the topics treated are up-to-date and lively and the interlocutors are skilful. If the discussion comes only at the end of the lesson, it is unlikely to introduce real interactivity into the educational process. However, in this way final explanations can be given and the participants’ opinions can be collected.

Some teachers like to use many real life examples in order to keep the listeners’ attention. This practice is good for illustrating the practical implications of the theoretical information conveyed; it may be particularly useful when the audience is less accustomed to educational activities.

Whatever the preferred methodology, most teachers use teaching aids to support their work. There are some speakers who use no material and place full trust in their ability to entertain the audience; however, if they are not blessed with the "gift of the gab", they may be not able to catalyse the listeners’ attention effectively. In most cases, the use of teaching aids is recommended; the table below lists the most common ones.

Some recently introduced forms of Information & Communication Technology (ICT) offer additional possibilities such as real-time or asynchronous connection with persons and groups at a distance, videoconferencing, distance learning, remote database querying, viewing material on World Wide Web sites, and searching on-line for certain material using Internet search engines.

Well-designed educational material may help to improve the richness and liveliness - and thus effectiveness - of educational initiatives. Such material may not have been produced specifically for educational purposes, but a skilled teacher can transform it into an educational tool. The most widespread materials are:

• printed material such as handouts, grids, leaflets, lists and directories;
• publications: reports, brochures, manuals;
• software: electronic versions of printed materials, multimedia presentations, demos, thematic CD ROMs;
• technical aids: in AT courses, AT devices that may be used as educational material themselves - by the teacher for explaining concepts and ways of doing things, and by the participants for hands-on experimentation.

For example...

If the educational initiative aims at educating expert teachers in the field of disability, some publicity leaflets can be used as educational material for critical analysis. Similarly, a publication on assistive devices compiled for information purposes can be used as a working tool during a lesson to assess its content and presentation.

The choice of learning setting is never independent of higher-order decisions, however some logistical aspects have an impact on the learning process or are even instrumental to learning objectives.

A residential course requires a remarkable organisational effort. Venues already fitted out for this purpose are called for, such as hotels or colleges with conference rooms, where concentration is aided and relationships among participants are fostered. Residential courses usually last from a weekend to a whole week, or even a fortnight.

Running a residential course requires a solid work group, where the spirit of co-operation and flexibility are strong. People who experience problems coping with their disability, for example, may initially find intense peer relationships psychologically demanding, and require some support. On the other hand, the residential situation often proves to be ideal for fostering stable learning and supporting personal change.

While the residential course is based on living together and sharing recreational activities as well, in the full immersion format group involvement - although intense and demanding - is limited to working hours only. Its pedagogical power lies in the concentration required of the participants, usually over a short duration.

Initiatives that are distributed over time, and even have random scheduling, may be monographic (with the audience varying according to the topic) or arranged in sequences of educational events addressing the same group.

Whatever the learning setting, the accessibility and availability of teaching aids should be a major area of attention, as well as other environmental features that favour psycho-physical well-being such as lighting and temperature control, furniture comfort both for participants (seats, tables for taking notes) and speakers. The seating arrangement depends on the type of educational activity and the didactical method employed: whereas a conference usually calls for the lecturer to speak in front of the audience, a seminar or workshop may involve informal arrangements like a circular lay-out at given stages. Hands-on sessions may require work in small groups, side by side, or done softly. Work groups focusing on planning and inventive tasks may benefit from conversation corners, which encourage intimacy and privacy.

Educational initiatives involving a sole teacher obviously do not need any co-ordination. If a teaching team is involved, the appointment of a co-ordinator is the most basic level of co-ordination. Usually the co-ordinator belongs to the organisation, so s/he is expected to know its mission and express its organisational, theoretical and pedagogical motivations. The co-ordinator handles contact between the various teachers, arrangement of schedules and timing, and decision-making on logistical issues. S/he should also be able to define clearly the educational framework so as to advise the teachers on contents to deliver, didactical methods and teaching styles. The co-ordinator is expected to provide the teachers with any information available on the trainees. It is up to him/her to judge whether the initiative is on track, consistent, and exhaustive, and if not whether s/he should intervene directly or guide the teachers to take action.

Co-ordinator duties may be supported or even taken over in some cases by a teaching team that meets regularly to monitor progress collectively, anticipate upcoming problems and tune the educational initiative. The team is particularly useful when the initiative is a demanding one with a long duration, and when relationships between participants are intense.

Organising educational initiatives without co-ordination is extremely risky. Employing resources in co-ordination will prove to be a good investment for success.

Back to Index.

5.1.1. Predisposition factors

Five factors can be identified that influence the individual’s level of understanding of the knowledge delivered to the group.

PREDISPOSITION FACTORS:

• Educational level
• illiteracy
• primary education
• secondary education
• higher education
• Awareness of diagnosis
• scant vs. in-depth knowledge of one’s own disabling condition
• Acquaintance with technology
• technophylia vs. technophobia
• Seniority of disability
• recent onset vs. prolonged disability
• Previous experience with AT
• no experience
• limited experience
• extensive experience

Becoming a proficient and successful user of AT certainly does not depend on educational level; however it is obvious that the depth of notions and the language used in transferring knowledge should be geared to the trainees’ educational background.

In some cases, educational prerequisites may be required. However, experience shows that these are not linked to the AT training itself but rather to the use that trainees will make of such training. For instance, if peer counselling is the objective, some previous experience may be required to ensure that the trainee is able to establish suitable relationships with clients.

When the trainee group comprises people of different levels, care may needed to avoid situations that exclude either those with lower education (overly demanding learning tasks) or those with higher education (boredom through the lack of challenge). Ways of managing this problem include:

· optional instructional tutorial or pre-courses, or

· separate sessions for in-depth study at given stages of the course, or

· simply making it clear from the outset what approach and language will be used.

In the last case, each participant will judge what is accessible to him/her (so it does not matter if something is not understood) or what s/he already knows (so it is seen as consolidation of knowledge, or as an opportunity to identify areas where one can be helpful to less expert people).

Awareness of the prognosis and the implications of one’s pathology or medical conditions underlying one’s disabilities may have remarkable consequences on the predisposition to pursue autonomy or use AT. In some cases, this awareness may be scant as a result of the user’s cognitive limitations, poor information received from health and rehabilitation professionals, psychological obstacles to "receiving the truth", or sometimes to rare disorders whose implications are not well documented.

The issue of AT often goes to the heart of problems related to disability. As acceptance of AT is linked to acceptance of one’s disability, people may feel uncomfortable speaking about this subject whenever it raises questions about the real truth surrounding personal status. Educators should be aware that scant awareness exposes people to possible negative psychological reactions, and they should therefore be prepared to cope with that.

Irrespective of educational level or cultural background, there are people who feel intimidated by technology and others who feel comfortable or even enthusiastic about it. One common example is the computer, which some see as a good friend while others dread like a foe.

Since AT is technology, and sometimes even leading-edge technology, it is important to devote special care to help technophobic people get acquainted with it. For example, these people may need to:

· handle and practice using technology more than others;

· confer with peers who are successful AT users;

· learn by practical example.

There are people who will never become effective users of technology. Nevertheless, no matter how deep-rooted it is, technophobia can always be reduced or overcome by helping such people look beyond technology and concentrate on what can be achieved by using it. An individual may not like sophisticated electronic wheelchairs, but s/he will be more likely to consider adopting one after experiencing how much faster, or more safely or comfortably important activities can be performed by using it.

In general terms, it is expected that the longer the personal experience of a disability, the more the person will become knowledgeable about its practical implications and "hidden sides" in daily life. The more time that has elapsed from the onset of the disability, the greater the likelihood that the personal adaptation process will have been completed. In other words, those with longer personal experience may be in a better position to know "what is best" for them.

The same may not apply to people with progressive pathologies that lead to a step-by-step progression of disability. Each "step down" leads to a new and as yet unknown situation, which may mean starting the adaptation process over again and thus possibly generating demotivation. This has implications for the predisposition toward receiving AT knowledge ("Why should I bother, if the situation is going to get worse anyway?"), and calls for special attention from educators. Due consideration should be given to the value of maintaining autonomy, which is not a poor cousin of improving autonomy.

People who have had previous experience using AT tend to be far better informed and more demanding AT consumers than novice users, who often seek to delegate choices to professionals. Highly experienced users may even be more knowledgeable in this field than professionals, since they live with AT round the clock and not only during working hours. People with no AT experience at all may need to learn aspects that are obvious for experienced people: even simple technical aids like adapted grips might not be properly understood if the usage technique is not illustrated in full detail. Within a course, it may be beneficial to promote interchange between people with solid experience and those without it.

It may seem contradictory to look upon disabilities as an issue here. However, there are two disability-related factors that influence the individual’s availability to receive knowledge being delivered to the group; both call for the educators’ attention in adjusting timing, language, and logistic arrangements.

DISABILITY-RELATED FACTORS:

• Physical stress tolerance
• short vs. long-term endurance
• Cognitive ability
• attention
• concentration
• memory

Some impairments derive from a pathology or medical status that limits endurance of physical stress. In such cases, overly long lessons or excessively short breaks make it impossible for the person to listen, participate and learn proficiently.

People with severe disabilities generally need to devote additional energy to tasks like taking notes or speaking with a communicator during lessons, reaching the bathroom and transferring to the toilet during breaks, and getting ready in the morning. This can make the whole day very physically demanding, thus reducing the energy available for educational activities. These aspects can be addressed through careful schedule planning; in addition, proper arrangement of the physical environment (e.g. selecting a course meeting room adjacent to toilets and resting rooms) also plays a very important role in optimising people’s energy use.

There is no "standard" level of cognitive ability, since everybody is differently gifted in terms of attention (ability to focus on the task), concentration (ability to participate in the task) and memory (ability to remember). However, there is a general understanding of what can be considered "average" attention, concentration and memory for people of different ages (consider the memory capacity of children and of the elderly).

With respect to this average, cognitive performance can sometimes be lowered by fatigue, by biological factors related to the specific pathology (e.g. multiple sclerosis or ALS) or to secondary consequences of disability (e.g. inability to communicate verbally).

An interactive teaching style may help to obtain timely feedback on the trainee’s participation in learning.

Motivation to learn is closely linked to acceptance or refusal of disability. Three factors can be identified that influence the individual’s motivation to receive the knowledge being delivered to the group.

THE INDIVIDUAL’S ATTITUDES TOWARDS DISABILITY:

• The individual’s image of disability
• labelling
• underestimation
• superman
• acknowledgement
• self-determination
• The individual’s image of AT
• extending abilities
• tool for living
• burden but need
• stigma of disability
• The individual’s feeling about autonomy
• independence vs. dependence desire

The way a person regards his/her disability may have a serious impact on the willingness to use AT. Educators should be aware of the continuum of possible attitudes, which can be clustered round five paradigms:

Labelling (rejection of difference): "I have been labelled as different, therefore I lack something. I am not a complete person. My label tells I am weak and dependent. I would like to be as able-bodied and powerful as others, but this will never be possible."

Underestimation (denial of difference): "People look at me as if I were different, but they are wrong - I am not different. The difference is only in their eyes: I have no special problem."

Superman (extraordinary difference): "My disability exists and I am proud of it. It is a challenge for me. Last year I climbed the highest mountain in Europe, now I’m preparing to climb Everest unaided. I want to demonstrate that people with disabilities are better and braver than others."

Acknowledgement of difference: "Disability affects some aspects of my life: I need somebody’s help in doing activities such as opening a can, feeding the fish, or taking a shower. I can do some activities by using technology in an intelligent way: I use the lift to overcome stairs, when I travel by train I get organised well in advance... Sometimes this condition is not particularly good, sometimes not really bad: isn’t that the same for any other person, after all?"

Self-determination: "I am a person with disabilities and I am aware of it. This condition is neither better nor worse than others, but it is certainly a special condition. We, persons with disabilities, have special needs, and may have to seek out knowledge to get the right solutions. Some of us may need technology, others personal assistance, and there are also those who only need to change their attitude towards disability. Some persons with disabilities look up to me as an example because I seem lively and active. They say I am a leader... perhaps I am. What I know is that I may always need some help from others, but I am definitely autonomous and I like to pursue independent living."

The individual’s image of AT is another factor that influences the willingness to learn and use AT. Usually it is closely linked to the image of disability, but not always: there are cases where disability is well accepted, but the person has poor information on AT that this is filtered through cultural paradigms.

AT can be seen positively as a tool for extending abilities ("it allows me to make the best use of the abilities I already have"). Alternatively, it can be seen positively but with less enthusiasm as a tool for living ("like any able-bodied person I use a pen to write, I just need a pen that has an augmented grip").

Less positively, AT can be perceived as something that is needed but makes life unpleasant ("I am forced to travel in a wheelchair"), or even as an exterior sign – a stigma- which "reminds me and others that I will never be able" ("I am confined to a wheelchair").

Depending on his/her self-image, the user may pay attention to aspects of AT (e.g. aesthetics, technical quality, etc) that are of little interest to less motivated people. One of the educators’ challenges is to promote positive attitudes towards AT where these do not yet exist.

There are people who strive to gain full control of their lives and people who do not feel motivated enough to take the lead in those aspects of life where they still depend psychologically, technically or financially on other people.

This may be linked to factors like age, temperament, previous history and experience, and existing relationships in the primary network. The individual’s feeling about autonomy is a dynamic process that evolves over time; AT education is often part of more comprehensive education addressing autonomy. AT and autonomy are interrelated: knowledge of AT facilitates the achievement of autonomy, and, in turn, autonomy increases interest in AT. Trainee groups often include people with a strong desire for independence and others who show limited or no desire - people who have full control over their lives and people who have none. This variation in attitude should be a matter of attention for educators.

Expectations of AT represent another predisposition factor that influences the individual’s willingness to learn. Given that autonomy can be described as the level of relational comfort with oneself, with the environment and with other people, it cannot be defined in absolute terms. It is related to the individual’s priorities and personality: in the same situation one individual may regard him/herself as autonomous, while another might feel restricted. Likewise, a person may experience both feelings in different periods of life as a result of personal growth. What makes the difference in these cases is the level of individual expectations. This term may well refer to life as a whole (general satisfaction or dissatisfaction with life); however, in this context we wish to focus on concrete objectives that the person wishes to set for him/herself.

THE INDIVIDUAL’S EXPECTATIONS:

• Expectations in the domain of inner relations
• self-esteem
• assertiveness
• problem-solving ability
• Expectations in the domain of daily activities
• range, preferences, priorities and value that each person assigns to various daily-life activities
• Expectations in the domain of outer relations
• range, value and depth of relationships with other people as desired by the individual

Expectations in the domain of inner relations concern aspects like self-esteem, acceptance of disability, assertiveness, perseverance, and decision-making and problem-solving abilities. An assistive device that meets expectations of this kind can be qualified as consonant to the individual. One individual may place great importance in the aesthetics of an assistive device, while another may find aesthetics merely a hindrance to functionality. This variance is often linked to socially agreed views and values, and may well depend on the local culture - an area that presents enormous variation throughout Europe.

Low expectations in these domains may pose barriers to the exploitation of AT potential. Conversely, unrealistic expectations may lead to frustration and dissatisfaction when not met. The failure of an assistive device is often the result of an unhappy experience associated to it.

Educators should devote attention to these aspects, estimate individual expectation levels, and make the user aware that appropriate AT can help meet expectations in this domain.

As stated earlier, AT must also be competent and contextual; in other words, it should make it possible to achieve the intended operational objectives, in the environment where they make sense.

This clearly depends on the user’s expectation level related to each activity of daily living, which in turn may depend on age, education, culture, disability, lifestyle before the disabling event, etc. The importance of some basic activities like personal care or carrying out a job is indisputable for the entire population. Nevertheless it is true that each individual prioritises daily activities differently: for one person, being independent in cooking and housekeeping may be a top priority, while for another the most important thing may be pursuit of a hobby or engaging in a social activity.

Such different views towards activities means that each individual will pay more or less attention to one topic or another as presented by the educators, as if s/he viewed AT through filtering glasses, so to speak. When interviewing participants after a course dealing with a broad range of AT topics, answers to the question "What aspect did you find most interesting?" commonly cover most of the topics - an indicator that there is also a wide spread of expectation levels.

Educators should be aware that the level of importance they place on the various topics might not correspond to each participant’s view. This calls for active-learning pedagogical approaches, where participants are offered the opportunity to focus on areas matching their individual expectations. What’s more, it may also require strategies that facilitate the re-definition of expectations.

Another aspect of contextuality is the human setting of each person’s activities.

Many daily-living activities have no meaning in themselves; they are just tools to establish relationships with other people. So individual expectations concerning the range, value and depth of outer relations in some way determines expectations in activity domains. Of course, all three domains are closely interrelated: an augmentative communication system for writing and talking (activity) may exert a dramatic influence on self-esteem (inner) and motivate the individual to take an active role in the community (outer); a social role in turn may activate the need for other activities (e.g. mobility) that previously attracted little interest. Very often a technical aid brings about positive results in activities that at first glance appear to have nothing to do with the purpose of the device.

Educators should be aware of the existence of these three domains, and of the correlation existing among them. This classification can be used as a tool for gaining insight into the participants’ expectations, as well as a tool their self-reflection.

Motivation is one of the key factors in learning. On the one hand, existing expectations can be used as a powerful tool to maximise learning. On the other, participants can be encouraged to modify those expectations in terms of either generating expectations towards aspects that were not considered before, or tuning expectations to a realistic level. Lectures and speeches can only increase awareness and knowledge of expectations; they are unable to generate them inside people. Conversely, much can be achieved by facilitating relationships among participants, leading to comparison of different expectations or even the creation of role-modelling experiences (a particular peer who has solved problems I feel are important can represent "a model for me").

5.2.1. Environmental factors

When trainees go back to their community, the challenge begins; it is time to put the knowledge received into action. However, the community may support or hinder the individual’s pursuit of autonomy and adoption of AT. Four factors related to human, physical and organisational aspects need to be addressed.

ENVIRONMENTAL FACTORS:

• Image of disability in the community
• labelling
• underestimation
• superman
• acknowledgement
• self-determination
• Architectural barriers
• accessible vs. inaccessible architectural environment
• Organisational barriers to the use of community services
• complexity
• cost
• co-ordination
• continuity
• attitude
• Living environment
• own home
• rented home
• institution
• small group
• supported living

The varied attitudes that persons may have towards their disability are often found in the community as well.

Although each member of the community holds an individual image, a general attitude ("public opinion") may often be encountered in the local community as a result of cultural heritage, previous experience of people with disabilities, human openness, and opinion leading in the media. The way AT is regarded forms part of this attitude, since public opinion usually relates AT directly to disability. Thus persons with disabilities who have developed a positive and active attitude often have to face prejudices and may find themselves in the position of "ground breakers" towards more civilised attitudes. This position may make them feel alone and uncomfortable with the "unwanted" public role they have to play in the community. This can lead to awkwardness and the urge to give up - fighting is tiring.

Conversely, a community in which the image of disability is positive and balanced may offer a very supportive environment for any initiative that the person wishes to take in order to solve his/her problems.

Educators should understand what societal attitudes await trainees when they go back home. Some educational exercises can be carried out to prepare them for possible demanding impacts.

Environmental accessibility is a prerequisite for any successful action. Architectural barriers in the community may not present an insurmountable problem, in that technical solutions are often available to overcome them. However, they may call for expensive AT and personal assistance set-ups that are not within everybody’s reach.

The greater the barriers, the higher the level of dependence the persons are exposed to, so high-level problem-solving abilities should be provided. Persons who live in an accessible environment may not even need to consider, say, overall wheelchair width, while others who everyday face curbs, steps, narrow doors, traps, badly parked cars and the like should expect any trip outdoors to be a kind of jungle safari where they can get stuck or find themselves in danger anywhere. These persons need to be "jungle-wise", which requires them to have greater experience, assertiveness, determination, tricks-of-hand and creativity than their "lucky" peers living in a civilised community.

In most countries such barriers are illegal, or at least there are provisions to encourage their elimination. In this case, a good empowerment tool is knowledge of such legally-established rights and the ways or procedures to activate intervention of the competent authorities.

Finally, those pioneers who confidently move about in public in spite of barriers may sometimes find themselves involuntarily become public figures. Their moving about attracts public interest towards them as living tokens of the faults in society. As stated earlier, not everybody feels comfortable when suddenly projected into a public role, and some may not resist the temptation to withdraw.

Nevertheless, educators can help to transform this problem into a challenge by pointing out that only the active presence of persons with disability in society can shape the societal culture. Many trainees are willing to take on this challenge - to go ahead not just for their own sake but also to shape public attitudes and prepare a better future for both themselves and other persons with disabilities.

Other barriers may exist in the community that are not related to the architectural environment but to the way public services are organised. We are not referring here to missing pieces in the jigsaw puzzle of accessibility arrangements, such as the classic "accessible bathroom that nobody can find the key to", a situation that should be considered an architectural barrier in the broad sense. What we are referring to here is people and procedures.

Any service, like an AT service delivery system or a municipal social service providing personal assistance, is of little use if not easily accessible to those who need it.

An initial barrier may be complexity, when people have trouble understanding where and whom to apply to, have to knock on many doors and receive only cryptic answers in bureaucratic language. A second barrier may be costs, represented not only by the actual charge for each set of services but also by any related human costs (time employed, effort spent in travel, etc) and material costs (transportation to reach the service centre, etc) borne by the user.

Co-ordination barriers may be encountered between the various steps of the service provision procedure, between the various professionals who participate in the process, or between interrelated services (e.g. AT service delivery and personal assistance; technical requirements imposed on AT that are obsolete with respect to current market standards; personal assistance regulations that conflict with labour legislation). Continuity barriers are often present in services whose organisation is adjusted to the staff’s rather than the users’ needs; users may find that the service is unavailable in the very moment they really need it and cannot wait.

Last but not least, it should not be overlooked that services are carried out by people (officers, health/social professionals, etc) whose attitude towards users can vary, thus greatly affecting service quality. From the users’ viewpoint, attitudinal barriers are often a major source of unreliability in services. Consequently, users tend to develop the attitude that you have to push hard to get what is due to you, but at the same time the individual may feel intimidated because power lies in the hands of exactly those people who represent the barrier.

Training users to get the most out of services, as well as developing abilities to overcome such barriers, is an important objective for educators.

The environment where the person regularly lives provides opportunities but at the same time may place limitations on what the user can really do in terms of AT.

In principle, users living in their own home can do whatever they like, since they own the spaces where the equipment will be used or installed. The situation is different for people living in a rented home, where all installations or adaptations should in principle be made in such a way that they can be removed after the resident leaves.

A situation where the user’s decisions are highly subjected to others is the institution, where in principle only mobile or movable equipment can be used at the user’s discretion, provided it places no burden on other residents or the personnel. Other types of living environments common among people with disability in Europe who wish to live independently are small group flats, where several users live together, or supported living, where users live alone or with their families but can rely on a round-the-clock assistance service for basic needs. Given that these set-ups are designed for people with disabilities, it would be reasonable to expect them to be arranged for extensive AT use; however, this is not always the case.

An issue that educators should bear in mind, and thus transmit to trainees, is "What does the living environment allow - or force - me to do?".

Facilities, services and competence are often available in the local community (or within easy reach) to support the individual in making informed, responsible and effective AT choices. However, such social supports may in some cases be lacking. Depending on the situation, educators may need to teach trainees how to get the most out of existing supports, or even how to act in their absence.

SOCIAL SUPPORT FACTORS:

• Information services
• databases
• catalogues
• guides
• publications
• exhibitions
• Counselling services
• technical aids advice services
• disability resource centres
• peer counselling
• Advocacy / management services
• practical assistance in implementing the individual’s initiative
• Health / rehabilitation facilities
• AT expertise of health/rehabilitation professionals in the local community
• AT service delivery system
• legislation
• procedures
• fixed list of prescribable devices
• user influence on decision
• appeal
• Public funding
• full funding
• substantial funding
• little funding
• no funding

If knowledge paves the way to understanding AT, information allows users to keep up-to-date on market developments and thus make use of their knowledge in the future as well. Since empowerment means having not only the "fish" in hand but also the "fishing rod", a major aspect of AT education is to enable people to find out information, or make use of information resources, on their own.

This should be based on thorough knowledge of the information sources that are within easy reach of the user. AT Databases are available in a number of countries, including Belgium, France, Germany, Great Britain and Italy. Not all of them are primarily intended for end-users, but anyone who has received basic AT training would have little difficulty understanding the information contained. The European Commission’s Handynet programme (part of the DG5/Helios project - 1988/96) is the largest European initiative that has so far been devoted to AT information. The Handynet database was produced on CD-ROM until 1997 and is now no longer available; however, the classification and description standards it generated have since been adopted for most databases in the field. This makes it fairly easy to interpret data when switching from one database to another.

Catalogues are the most common commercial method of product information. Printed catalogues are still the most familiar and attractive way to access information, and in fact they are the only means accessible to people who do not use a computer.

Research centres, information services, and even some firms produce valuable guides that offer an outlook on AT topics (e.g. choosing a wheelchair, getting funding from the SDS, etc). In some countries there is also a wealth of accurate, well-designed publications that are easy for AT users to understand. Unfortunately, such resources are not available in all countries, and not everyone is able to read English or French, the languages in which most of the publications in this field are produced.

Some of the above information can be found on the Internet, in the form of web sites on disability, online databases accessible from WWW, or on-line catalogues or guides. Currently, there is an international trend popularly called the Worldwide AT Information Network to interconnect the various existing information systems on the World Wide Web. This is still in the early days, and is destined to evolve rapidly in directions that are difficult to foresee today.

Finally, a significant role in the dissemination of AT information is played by commercial exhibitions, which are held regularly in each country.

Advice, guidance and counselling services addressing the individual offer a tremendous opportunity for persons with disabilities. They can provide specific knowledge and expertise whenever a decision in AT is to be made, or simply when some help in clarifying needs is required.

Educators should be aware that it is virtually impossible to provide trainees with the ability to solve all their AT problems just through an educational curriculum. Needs evolve over time, horizons shift, technology develops, and medical conditions or health status may undergo modification, so the individual is called upon to make new choices and decisions every day. Therefore, when concluding an educational process it is important to help the trainee identify services, places and people to refer to whenever guidance is needed.

Some parts of Europe are quite well served, while others are almost completely lacking in such services or, if they do have them, offer low-grade expertise. If suitable services are not in place in the community where the person lives, the user can be helped to get in contact with quality services located elsewhere. Distance may be a problem, but having something far away is much better than having nothing nearby: knowing that there is somebody ready to help at the other end of a telephone line makes a big difference.

In some countries technical aids advice services are common. These provide information, guidance, advice and counselling to individual end-users, family members, rehabilitation professionals, and technologists looking after disabled clients. These services are sometimes located within rehabilitation departments of hospitals or community services, or alternatively are stand-alone centres set up by public bodies, insurance agencies or users organisations. The coverage and level of expertise they can provide varies greatly, depending on the size and qualification of the staff, the information resources used (databases, catalogues, etc), and the possibility of seeing and trying out technical aids on permanent display. The staff in some centres is made up exclusively of information officers with basic AT training. Others have an interdisciplinary staff of clinical professionals and technologists who are able to carry out a thorough assessment (often including home inspections) and thus provide detailed recommendations for individual AT programmes. Then there are other centres that play a "gatekeeping" role in AT service delivery, in that they have responsibility for prescribing individual AT programmes, installing and fitting devices, training users and ensuring maintenance.

Disability resource centres are another valuable facility, where a broader spectrum of information is offered to people with disabilities, covering AT, legislation, benefits, community services, accessible tourism, events and initiatives, literature and the like. Covering such a wide scope, these centres obviously provide less specialised AT assistance than technical aids advice services do; however, they are always extremely useful early guidance points.

Another service that may be available is peer counselling, either on an informal basis or formally structured at both group level (e.g. self-help or mutual-help groups) and individual level (experienced AT users on hand to discuss possible problem-solving approaches with novice users). Peer counselling should not be seen as an alternative to professional counselling, since their objectives are very different.

Educators should understand the value of both forms of counselling, and try to teach trainees to be good users of such services and to co-operate with them as far as possible.

These are services whose mission is to assist users in carrying out the steps involved in solving a problem. This can be done by advocating users’ rights before competent bodies, or even by acting on the user’s behalf in handling complex matters, administrative procedures, shipping and handling operations, aggressive adversaries, etc, in order to implemented fully the individual’s initiative. Indeed, advocacy and management services help to overcome organisational barriers in society, which present a major threat to the user’s power.

Such services are sometimes offered by companies on a commercial basis, where the user pays periodical subscriptions or single-service fees. However, they are more commonly offered by non-profit user organisations committed to the empowerment of people with disabilities (in both the political and social sense).

Educators should know whether advocacy services exist and encourage trainees to get in touch with them.

In recent years, professionals in the health and social service fields have acquired greater understanding of the role of AT, even though in many countries AT is barely covered in their academic training.

Thorough knowledge of AT should be a fundamental attribute of a good rehabilitation team: it is a prerequisite for consistency between AT and therapeutic decision-making, the individual’s lifestyle and priorities, and economic resources. Many rehabilitation services have expert knowledge, with clinical protocols that hold AT in the highest consideration, occupational therapists with solid AT experience, specialised technologists like prosthetists or rehabilitation engineers, technical aids advice services, educational programmes for end users, facilities for self-organised peer counselling, and so on.

By contrast, the focus in many other centres is on strictly medical aspects, AT intervention being considered as somehow external to the team’s responsibility. In this case the end-user may be left with nothing but a filled-in prescription form in his/her hands, and have to set out alone to find a commercial AT supplier that will really look after his/her problem. It is not uncommon to find users whose problems do not receive due consideration simply because the prescriber’s AT expertise was inadequate.

In principle, most persons with disabilities will not need rehabilitation services unless their medical condition specifically requires it. However, keeping in contact with rehabilitation teams may be necessary in those countries where access to publicly-funded AT is granted through medical prescriptions. Educators should help the trainee to evaluate the AT expertise of professionals, and choose, wherever possible, those services that are likely to provide a high level of competence. The best weapon against the ignorance of others is knowledge and information; informed, demanding, assertive and responsible users can challenge public services and demand suitable responses, thus leading to service improvement in the long run.

End-users are very keen to learn about the systems they have access to. In courses attended by people from different countries with different SDSs, few trainees are particularly interested in finding out about other systems: they wish to concentrate on the SDS they themselves will use, like "a car that is worth learning to drive perfectly". That is one reason why training in SDSs should be tailored to the contexts in which the trainees live.

The SDS is rooted in legislation, and the trainee should understand - if not the details - the philosophy, approach and future evolution. In times when welfare legislation is undergoing fundamental reform, it is important for end-users to understand what is changing and why. They should be made aware of the major tools for following such changes, i.e. the mass media and specialised information sources like online legislation databases specialising in disability matters.

If legislation states what it is possible to do, procedures establish how to do it. Procedures are described in official documents, but many people find the bureaucratic language used to be cryptic. It is more important to gain practical knowledge through examples and case studies that:

• describe problem-solving situations;
• illustrate how failures sometimes lie not so much in the procedures themselves but in the people responsible their implementation;
• challenge trainees to overcome obstacles.

Another important subject to cover is the fixed list of prescribable devices, if the SDS has one, so as to be able to forecast if the related application is likely to be successful or not.

Finally, it is important to know the level of user influence such procedures allow and how to make use of that right, including the ways to appeal (where this is possible) against professional decisions that the end-user deems to be wrong.

Wealth may not necessarily lead to happiness, but neither does the lack of money. The availability of public funding for AT makes a real difference to people whose wallet is not fat.

So economic considerations assume increasing weight in the choice of AT the further we move away from full or substantial funding to contexts where little or even no funding is provided. In the more favourable contexts, attention should chiefly be focused on SDS procedures, which may sometimes be quite complex and need sorting out with the help of an advocacy service, but will finally ensure that the desired technology is in place. In the less favourable contexts, attention may be shifted to the best ways of evaluating a device’s cost-benefit ratio, and to establishing which devices are top priority and which are useful but not necessary.

In any case, the cost-benefit issue should be given proper consideration in AT education. With full or substantial funding, it is presumed that professional services are capable of evaluating the cost-benefit ratio of the device to be funded. However, the user’s assessment may sometimes class with the professional judgement. The more the user thinks in terms of cost-benefits, the stronger his/her negotiation position with professionals will be. Where little or no funding is available, the user bears the direct economic consequence of his/her choices, so once again performing cost/benefit analysis it of prime importance. Cost analysis should not be restricted to the purchase/investment cost of the AT device, but should also include costs related to maintenance, associated services, and the personal assistance required. As a basis for comparison, trainers should present the cost of not having the device.

The existence of an effective AT market is to some extent a prerequisite for freedom of choice. Educators should know the ins and outs of the AT market so as to guide trainees to negotiate good terms with providers or suppliers. As shown below, there are five market factors that influence end-users’ accessibility to AT.

MARKET FACTORS:

• Purchase cost
• insignificant
• affordable
• unaffordable
• Maintenance cost
• insignificant
• affordable
• unaffordable
• Range of available products
• limited vs. comprehensive
• Product design factors
• safety
• standardisation/certification
• ergonomics
• robustness
• performance
• compatibility
• upgradability
• aesthetics
• Supply service quality
• pre-purchase trial
• sales
• after-sale service
• training
• maintenance
• recycling
• renting

Since AT encompasses an array of products and services that range widely in cost, it is impossible to deal with this topic in general terms. Some AT products are accessible to anybody free of charge (e.g. free-domain software), while others cost many thousands of Euros (e.g. a sophisticated electronic wheelchair, or an eye-gaze-operated computer control). Since it makes no sense to define costs in absolute terms, they should be looked at from the end-user’s viewpoint. The cost of the device may not correspond to the actual purchase price, but just to the amount of money the user personally has to disburse. For instance, the user considers an expensive device that has been paid for entirely by the state as costing zero.

Therefore the cost issue should be approached in terms of the individual’s situation, which depends on the kind of technology needed, the wealth of the would-be user, and the market situation and SDS provisions in the country or region concerned. Within an educational programme, the cost topic should be dealt with in terms of designing funding strategies and exerting market influence, instead of fruitlessly complaining about the high cost of AT.

This is why it is more correct to speak - and encourage the trainees to speak - in relative terms like insignificant / affordable / unaffordable than in absolute terms like low / medium / high cost. A very rich person may regard the price of an expensive device as an insignificant cost even if s/he has to cover it completely out of his/her own pocket. On the other hand, even if 90% of the cost of the same device is covered by the National Health Service, the remainder might still represent an unaffordable cost for a poor person.

Finally, users should be helped to evaluate the real purchase price, which may differ from the figures shown in the supplier’s price-lists. The term real cost refers to the device installed and ready to serve the person’s autonomy, which may incur assessment costs, shipping and handling, installation, fitting, personalisation, and last but not least the cost of training to use it properly. In other words, real cost is the cost of having the problem solved.

The maintenance cost is often an underestimated factor. Therefore, if educators decide to enter the cost issue, they should bear in mind that from the users’ viewpoint maintenance cost is a major issue.

An AT device, or a mix of AT devices serving a given purpose, serves the user for a certain period in which resources are needed for maintenance. Some SDSs also cover maintenance, but more commonly the user him/herself will have to provide for maintenance even if the device was purchased with public funds. The above considerations also apply to maintenance costs, so once again it is improper to speak in terms of low/medium/high cost; the categories insignificant/ affordable/unaffordable are more meaningful.

Maintenance is a running cost that includes both technology-related and human assistance-related aspects. Cleaning, electricity, repairs, spare parts etc. are technology-related costs that are incurred continuously or at regular intervals in order to ensure that AT works well for its whole technical lifetime. Some devices may also involve associated services; for example, taking a bulky wheelchair on a long-distance trip may entail hiring a special transport service. Assistance-related costs concern the nature and amount of human resources needed to get the AT solution working. For instance, a pushchair makes sense only if pushed by a personal assistant. It is often difficult to calculate such costs in monetary terms because they mainly comprise man-hours, which may be paid for or not depending on whether a formal or informal helper is used. In any case, man-hours are a resource that is drawn on and thus a cost to be considered.

AT choices are necessarily limited by the range of products and services available on the market.

However, a distinction should be drawn between the theoretical market range, i.e. the entire range of products available somewhere in the world at any given time, the real market range, comprising products actually accessible to a specific person living in a certain place, and the apparent market range, i.e. what the user thinks is available.

The extent of the apparent market range does not depend solely on the spread of AT retailers throughout the territory; it depends greatly on the person’s ability to look around and get in touch with a supplier. Those who have always lived in the same place and have little experience of the outside world may view the market range in terms of the three of four retailers in town, whose decisions about what devices to stock or display are guided by commercial considerations. Consequently, they are highly dependent on the vendors’ proposals and may be quite disadvantaged if they live in badly served areas. By contrast, a well-travelled person who visits exhibitions, speaks a foreign language, is assertive with vendors and asks to be regularly informed may get a more realistic picture of the AT market; he or she will probably evaluate the quality of products and suppliers, and analyse a wider range of offers whenever a choice is called for.

Technical aids advice services play a very important role in helping users to broaden their view of the apparent market and match it to the real market range. Since the aim of retailers is to sell their goods, they cannot be expected to provide the kind of unbiased advice expected of a technical aids advice centre. Therefore, the problem can be overcome to a certain extent by encouraging AT users to get independent advice before deciding.

At the same time, the root of the problem is to train users to become informed and responsible consumers who understand what the real market is. Moving from individual to group level, another dimension of the problem is to promote consumers’ initiatives to bring about an improvement in the real market range. These considerations pose quite interesting challenges for educators.

The effectiveness and utility of AT depends not only on appropriate choice of the individual AT programme, but also on the technical quality of the products themselves.

Devices that frequently fail, that require undue effort from the user, or that are incompatible with the environment or with other devices may generate more problems than they solve. What’s more, they may not actually permit the user to reach the expected objectives, resulting in frustration and loss of autonomy.

Therefore, it is important to understand what level of quality can be expected and required of products. In its popular meaning, quality is not seen in absolute terms but with respect to the specific context of use; it is the quality of the solution, rather than the quality of the device, that is of interest to the user. However, product design characteristics often play a fundamental role in ensuring a good-quality solution, especially in a tough environment (think of an electronic wheelchair for a person living in a place with steep slopes).

There are many parameters that affect the technical quality of the device. Educators should strive to help end-users make their own evaluation of product quality, and to understand the meaning of certification labels they may find on their products. This does not mean that users need to know the complex technical details of standardisation requirements; what is important is to understand that when a "medical device" such as a wheelchair bears a CE label, this guarantees that some fundamental safety requirements have been met, and so the manufacturer is liable for any injury or damage the user may incur due to technical failure.

Other aspects that should be evaluated include: ergonomics, i.e. the way the product matches the user’s characteristics and abilities; robustness and performance; compatibility, i.e. suitability for environmental constraints and association with other AT devices; and upgradability, i.e. the possibility to modify, augment or improve the device in response to changing user needs (consider a seating system for children), or technological advances (consider a computer interface).

Today, all these aspects tend to be grouped together as part of good product design. In addition, the concept of usability - and usability engineering - has recently been introduced to identify the overall set of attributes that result in products gaining strong consumer acceptance, e.g. effectiveness, efficiency, safety, comfort etc.

Another important aspect, although subjectively weighted, is aesthetics. Educators should help users to appreciate this factor, since AT devices are often objects that integrate with body image or with home furnishing, and thus should reflect the user’s taste and personality.

The story does not finish when a device has been chosen: the user can expect to face many other problems.

Choosing a good supplier may sometimes be more difficult than choosing the device itself. The same device is often supplied by different vendors with widely varying price and service conditions, and it is not always true that the closer the supplier, the better the service. The ability to negotiate good terms with a supplier is an important issue that educators should consider well. It involves knowing what constitutes good practice in product supply, and being aware of potential problems that may arise at any step in the supply/service chain.

The offer of a pre-purchase trial is a sure indicator of quality; the potential buyer can avoid many traps by testing out the device before purchase. This service is not always on offer, especially when the vendor is a small firm that has, say, imported an expensive piece of equipment. However, a sense of the firm’s willingness to serve the customer and not just sell goods can anyway be gained from the initial impression.

The sales conditions may contain surprises like unexpected surcharges for "mandatory" accessories, packaging and delivery, which the user can easily avoid if trained to find out all cost items beforehand. At this stage, the user should be eager to negotiate possible alternative payment schemes (e.g. leasing), and after-sale service conditions like warranty. The user should also be informed about any training needs, about who is to provide that training, and whether it involves additional costs. Clear information should be sought from the supplier about expected maintenance, what to do in case of repair, whether maintenance schemes exist, and the related costs. Finally, it is worth knowing what to do if the device becomes obsolete for some reason before reaching the end of its lifetime, for instance whether it can be recycled for reuse by others. It may also be worth exploring the possibility of rental when the AT is for temporary use, especially in the case of expensive equipment.

The primary network around the user (family, friends and others who figure significantly) certainly has an influence on the design and implementation of the individual AT programme. Four factors need to be considered in this respect.

SOCIAL NETWORK FACTORS:

• Expectations of the family / primary network
• eagerness vs. resistance to change
• favouring vs. restraining independence
• Expectations of professionals
• AT consistency vs. inconsistency with the individual’s rehabilitation programme
• Expectations of the outer network
• role of the individual in the community
• Role modelling
• presence in the network of peers looked up to as models

AT programmes often have an impact not only on the individual but also on the whole system of primary relationships.

Within the system, the role and weight of the various members with respect to disability problems and AT differs from one case to another, and can even vary over time. There are cases in which the individual with disability does not need to consider the views of others; cases where s/he chooses to share life with others; cases where a wider group is involved; and even cases where the actual end-users of AT are the helpers. In turn, there may be cases where technology is well accepted by the individual but not by the primary network; cases where technology is aimed at family relief rather than at the individual with disabilities; and cases where technology simultaneously offers direct support to the individual and indirect support through the primary network.

Some aspects of the individual’s life project are hard to separate from the family’s life project. A range of expectations may originate from the relationship with the spouse, who in turn may have other needs and aspirations that are then shared by the partner. The introduction of AT in a family may call for personal changes among family members. It may also require modifications in the organisation of personal assistance, and thus a change in the attitudes and habits of personal assistants. The success of the same technology provided to the same person may vary if placed within a different primary network.

In all these cases, the members of the primary network can have an influence and a role in the choice and use of AT. They may endorse back or resist the lifestyle changes brought about by the introduction of AT; they may represent incentives or disincentives towards independence and freedom of choice. It is not a matter of having good or bad companions in life, but of recognising that not everybody will find changing habits and lifestyle so easy or pleasant.

Educators should help AT users prepare for potential conflicts. At the same time, they should train the primary network to respect the views of others, be assertive in pursuing vital goals, work towards changing attitudes within the network, and wait patiently for changes to take effect.

It is not always true that the expectations of rehabilitation professionals and AT providers necessarily match those of the individual. What professionals consider as "best for you" is generally seen by an assertive AT user as a respected opinion, an expert suggestion that is worth considering, but not the only option.

Good rehabilitation professionals are aware that they should play the role of educators in helping the user to discover new horizons or perspectives on life that are often unexpected when the person is stuck with personal, physical and psychological problems. But they should also be aware that each individual has his/her own life priorities, so "golden rules" in rehabilitation practice are to be seen not as absolute truth, but as guides to actions that need to be tailored to the individual’s actual priorities.

Thus gaps can sometimes be expected between the views of the professional and those of the user, who should be aware of this potential discrepancy. Users should take advantage of the potential that this gap offers in terms of challenge, reflection about unexplored issues, and building of a dialogue and partnership with professionals.

Professionals may be looking at aspects like prevention of medical complications, functional rehabilitation, educational or vocational objectives etc, and thus approach AT in terms of the effectiveness it offers in reaching those objectives. The user may place greater priority on other aspects, ones that the professional would judge less important but that have greater utility for him or her. The result is that s/he may place obstacles to the rehabilitation treatment as designed by the physician. It is not uncommon to encounter situations where AT programmes generate conflicts between the user and professionals, or even clashes within the professional community. The latter situation may be due to differences in professional background, the different bodies involved, lack of co-ordination, or even lack of knowledge.

To be prepared for such a situation, it is important that the user has a positive attitude towards professionals and understands the objective difficulty of identifying "the truth" in complex situations where different truths co-exist. By the same token, they should never take it for granted that all professionals know AT in depth. In other words, users should be led to regard themselves as active protagonists in their rehabilitation.

Last but not least, AT is in most cases affected to some extent by the local community in which the person lives.

Reintegration in the community may involve reorganising services like transport, adjusting the milieu where the individual with a disability lives (e.g. logistics, workflow, relationships in the workplace), and modelling social attitudes. For instance, the removal of architectural barriers to integrate a disabled person in a school will make it easier to integrate others in the future, in both practical and cultural terms. In other words, the visible presence in the community of members with disabilities brings about a cultural change. In communities where it is common to see persons with disabilities taking part in social life on an equal footing, it may be easier for those who are not born pioneers to reintegrate.

The term "expectations" can be used to define the practical consequences of social attitudes towards disabilities. In an integrated community, people may find nothing unusual in a visually impaired person walking alone in the street with an assistive device or taking the initiative in asking for help when it’s needed, and any passer-by will be glad to offer the required help. In such communities, things like offering a bus seat to an older person, or helping a disabled workmate have lunch or go to the bathroom tend to be considered no more that the civilised behaviour one would expect of a "normal" polite person. Conversely, many people in other communities would not expect an AT user to go around alone, and would feel quite embarrassed and at a loss when encountering such a person. They may think that responsibility for assistance lies solely with professional services, and admire the small minority of "saints" who feel comfortable with disabled persons "even if they are not paid to look after them".

It is important that users are led to understand the societal expectations towards each of them, in order to be prepared for the awkward situations they may find themselves in. As was the case for the primary network, the user can act as a community educator and promote changes in expectations.

In this context, role modelling can be described as the self-identification of an AT user with a peer who has apparently been successful in solving problems that are felt to be important. "I like the way s/he is coping - I would like to be him/her" is a typical common made by a person with disabilities who is looking at another AT user as a role model.

Seeing living examples of what the user feels to be a "better situation" represents a powerful tool not only for motivation and challenge, but also for identifying hidden needs. Educators can approach the issue of role modelling from three different perspectives: the presence in the teaching staff or trainee group of people that have role model characteristics; the presence in the living environment of other AT users that can be considered role models ("When you go back home, have a look at how what’s-his-name has organised his flat"); and the potential of each trainee to become (consciously or unconsciously) a role model in his or her community.

Back to Index.

6.1.1. Context

Centro Studi Prisma was founded in Belluno (Italy) in 1984 as an interdisciplinary association for information and research into technical and social aspects of independent living and social integration of people with disabilities. It is a cultural association composed of people from all over Italy who are professionally or personally engaged in the field of disability, most of them being disabled persons themselves. Based on an interdisciplinary approach, Centro Studi Prisma works to promote culture, information and knowledge concerning all aspects of rehabilitation, social integration and independent living. The underlying idea is that knowledge is the fundamental basis for helping to remove social, cultural and technical barriers that hinder full participation of disabled persons in society.

Pursuing the idea that disabled persons’ daily experience with disability makes them the main actors in their social integration, Centro Studi Prisma has held training courses every summer since 1985: these were originally entitled "Disability and Daily Life: Education Toward Independent Living" and are now also called first-level courses. They are addressed to adults of various ages (including the elderly) with motor and other disabilities - heterogeneity is preferred. The courses are also addressed to personal assistants, who fully participate by attending the same programme (with the exception of group-work sessions, which they attend separately from disabled participants). Up to 1998, the first level course was attended by 274 persons with disabilities and 243 personal assistants from all over Italy and from abroad.

In 1988 the training programme was extended to include a second-level course entitled "Disability and Society: Promotion of Independent Living", in which the participants are encouraged to act as promoters of independent living in their communities. Before being admitted to this course, participants must have completed the first level course. Up to 1998, four editions were held, attended by 89 persons with disabilities and 75 personal assistants.

Both courses are entirely organised, directed and run by a team of experts who have disabilities themselves. Several teachers without disability were invited to join the staff in order to widen its areas of expertise.

The concept of autonomy is central to these courses and AT plays a key role. Independent living is viewed as a way of approaching life and coping actively with disability, on the understanding that nobody is fully independent, everyone depending in some way on others. Trainees are helped to gain awareness of the value of their personal experience, to practice rationalising it when solving daily life problems, and possibly to make use of it for role modelling or peer-counselling for others with disabilities. The programme of the first-level course mostly focuses on technical components of AT education, however some human and socio-economic subjects are also dealt with. The second-level course focuses exclusively on human and socio-economic issues, addressing topics such as combating social prejudice towards disability and AT. On the whole, the courses provide comprehensive training on AT, help to shape users’ attitudes towards taking control of their lives, and favour the exploitation of personal experience of disability for social growth.

In 1998, Prisma held the fourteenth edition of the first-level course together with the tenth edition of the second-level course. A preliminary announcement was circulated at the beginning of the year containing information about general course objectives, the venue, the duration and dates. These aspects had been decided the previous summer at the conclusion of the previous edition.

In March, the Prisma staff met to plan the courses operationally and organise them. At that meeting a number of responsibilities were assigned: appointments included a course co-ordinator (director), teaching staff (four experts), five group work co-ordinators, an organisational manager and the secretariat. A final programme was worked out, practicalities were defined, and deadlines for the launching stage were established.

The chosen location was a holiday resort in the Dolomite Mountains lying 1,200 metres above sea level; this resort is fully accessible to people with disabilities but open to the general public. The venue was the same used for previous editions, since it had proved highly satisfactory in terms of general comfort, overall accessibility, lodging and bathroom accessibility, aesthetics and seating arrangements, as well as being set in a fresh and healthy location. Favourable accommodation rates were negotiated, and an individual registration fee for trainees was fixed in order to cover some of the costs of the course.

The courses were widely publicised by means of leaflets (sent out to the addresses contained in the Prisma database), articles in specialised journals, announcements on local television, and, for the second-level course, by contacting those who participated in previous editions of level one. Leaflets were also sent out to voluntary organisations, technical aids information centres, rehabilitation centres, as well as being handed out at congresses and exhibitions. Information was also spread by word of mouth.

As the courses were aimed at a very specific target and had well-defined learning objectives, it was important to ensure the participation of suitable trainees. A selection procedure was established and a person internally referred to as the filter was appointed to implement it. The filter interviewed candidates over the phone and filled-in a confidential form divided into two parts, one for general information on the candidate and the other for the compiler’s notes. The filter’s main tasks were to:

1. collect essential information on the candidate (disabilities, life context, autonomy etc);
2. provide the candidate with as much information as possible on the course;
3. understand the candidate’s motivations for attending the course;
4. verify that the candidate had read the programme carefully and had understood that the course was residential;
5. give accommodation details and find out whether the candidate was willing to room with others;
6. explain that the organisers were unable to offer personal assistance during the course, so candidates had to bring their personal assistant if needed;
7. find out any special practical needs the participant may have, including possible medical needs requiring health facilities available at easy reach.

The filter sought to talk personally with each candidate. However, this was not possible in all cases because some candidates with severe communication problems could not manage a phone conversation. Consequently, it was sometimes necessary to talk with relatives, assistants, or even rehabilitation professionals who had proposed the course to their clients.

The information collected during this phase was essential not only for admitting participants, but also for other purposes, including:

1. logistic organisation - accommodating for the various levels of independence, mobility problems, specific needs, habits, difficulties, accompanying persons;
2. composition of work groups - established before the start of the course so as to separate persons with disabilities from personal assistants, and make each group as heterogeneous as possible in terms of age, geographic origin, pathology and disablement;
3. adjustment of teaching contents and style in response to the participants’ cultural background and level of autonomy.

At the end of the selection process, 26 persons with disabilities and 27 personal assistants were recruited for the two courses. Their ages ranged from 18 to 75, the average being forty. The disabilities originated from a wide variety of pathologies, some of them progressive. Some persons also had verbal communication impairments.

FIRST LEVEL COURSE - PROGRAMME:

• Sunday 26/7/98
• Arrival / accommodation
• Welcome session
1. Introduction to the course
• Monday 27/7/98
• General concepts
1. Impairment, disability, handicap
2. Accessibility, assistive devices
• Group-work No. 1
1. Definition of autonomy
• Tuesday 28/7/98
• Personal Care
1. Organising the home
2. Personal hygiene and body care
• Group-work No. 2
1. Adapting a flat to participant needs
• Wednesday 29/7/98
• Wheelchairs and seating
1. Manual and electronic wheelchairs
2. Seating systems
• Legislation
1. Italy’s legislative framework
2. Regulations on AT and accessibility
• Thursday 30/7/98
• Outdoor environment
1. AT for outdoor mobility
2. AT for leisure and sport
• Social programme
1. Outing in the Dolomite Mountains
• Friday 31/7/98
• Comunication
1. AT for communication
2. Environmental control and telecommunication devices
3. Corporeity aspects: body, communication, sexuality
• Group-work No. 3
1. The individual, family and society
• Saturday 1/8/98
• Computer access
1. Computer-based AT
2. Technical aids exhibition
• Information resources
1. The SIVA information network
2. Centro Studi Prisma
3. Networks in the European Union
• Farewell session
1. Course Evaluation
• Sunday 2/8/98
• Departure

SECOND LEVEL COURSE - PROGRAMME:

• Sunday 2/8/98
• Arrival / accommodation
• Welcome session
• Monday 3/8/98
• Social image of disability
1. Disability and AT in the mass-media
2. Analysis of contents in the media
• Group-work No. 1
1. Analysis of messages
• Tuesday 4/8/98
• Disability and School
1. Disability and AT as educational experiences
• Group-work No. 2
1. Bringing the disability experience to the school
• Wednesday 5/8/98
• Human relationships
1. Talking techniques and group dynamics
• Group-work No. 3
1. Practising relationships
• Thursday 6/8/98
• Organisational techniques
1. Peer counselling and peer mentoring
2. Setting up AT information services
• Group-work No. 4
1. Organising educational initiatives
• Friday 7/8/98
• Social image of disability
1. Creating messages
• Group-work No. 5
1. Interviewing
• Saturday 8/8/98
• Acting and networking
1. Promotion of autonomy in local communities
• Farewell session
1. Course Evaluation

COURSES TIMETABLE:

• 9.00: Lesson
• 10.30: Coffee Break
• 11.00: Lesson
• 13.00: Lunch
• 16.00: Group-work or Lesson
• 17.30: Coffee Break
• 18.00: Discussion or Lesson
• 20.00: Dinner
• 21.30: Social programme

As the courses were residential, great attention was paid to accommodation matters (distribution of rooms, time necessary to get ready in the morning, etc).

Educational co-ordination involved the whole staff (director, teachers and group work co-ordinators) attending two progress meetings scheduled on Monday and Thursday at 9.30 p.m., and a final evaluation meeting held on Sunday morning from 9 a.m. to 1 p.m.

The director’s tasks were to ensure the coherence of the course, co-ordinate all teaching matters, and make any organisational and financial decisions. He co-ordinated the team meetings, attended all the lessons, and - with the help of the other teachers - prepared the educational material, the handouts and the group-work material. He also had to ensure that all aspects adhered to the mission, approach and style of Centro Studi Prisma. To this end, the directors of the various editions over the years were people who had been first trainees in both the first and second-level courses, then group work co-ordinators, and possibly also teachers. Strong co-ordination proved to be extremely important for the success of the course.

Most lessons were in the form of a lecture. Teachers were asked to use simple language, to include numerous examples, and make extensive use of overhead, slide, video and computer presentations. In each lesson, handouts were distributed listing the main concepts covered, so as to facilitate understanding and memorisation, and prepare for the group work to be held in the afternoon. Interactivity, discussion, learning by doing and good presentation were the four keywords used by the teachers to describe their preferred learning style.

The lectures were aimed at introducing basic concepts, problems and solutions related to daily living with a disability; AT products were sometimes presented and demonstrated. Whenever possible, the whole teaching staff attended each lecture, so as to ensure solid feedback afterwards and to avoid repetitions or gaps. This did not limit each teacher’s freedom to choose teaching style, since differences in style were greatly appreciated and considered valuable. The development of topics within each lesson was often sorted so as to start from the body level, then gradually expand to wider living spaces such as the person, the home, the neighbour, the town and the world.

Each teacher was selected on the grounds of his/her competence and experience in the assigned subject. At competence parity, preference was given to candidates with a disability (being able to speak from "inside the disability"), maturity (being able to speak from "outside the disability"), and ability to communicate positively.

Each group work session was led by a work-group co-ordinator. All the co-ordinators were persons with disabilities, chosen for their experience, competence and reliability, as well for having participated in previous editions of the course. In the first level course, the participants were divided into five work groups, three of them composed of disabled persons (eight per group) and the other two of their personal assistants (nine per group). The groups of participants with disability were heterogeneous in terms of disability, age, sex and place of origin. The groups of personal assistants were heterogeneous in terms of role (family member, friend, volunteer, professional, etc), age, sex, and place of origin. At the end of each group-work session, the groups presented the results of their studies in a plenary session.

During the breaks in the first-level course, a professional AT expert - herself a person with disabilities and a member of the Prisma staff - was available upon appointment to discuss personally individual problems that could be solved by AT. The chosen setting was one deemed appropriate for conversation and equipped with a computer for browsing the SIVA CD-ROM (the Italian Assistive Technology database).

An exhibition of selected AT devices was also set up on the last day of the first-level course, in co-operation with some AT suppliers. As well as viewing the products on show, participants were invited to share their personal experiences of AT (home arrangements, aids, inventions, tips for autonomy, etc) and to illustrate them with slides, photos and the like.

Although offered as optional activities, the social events were designed to be consistent with the course mission. The social programme of the first-level course consisted of four evening meetings:

• videos on subjects covered in the day’s lessons (Monday);
• meeting with representatives from the region’s user organisations (Wednesday);
• meeting with representatives from the local authorities (Friday);
• farewell party organised by the participants themselves (Saturday).

In addition, an outing in the Dolomites was organised for Thursday afternoon, including a visit to beauty spots, a ride along the area’s one accessible mountain trail, a ride up to a mountain top in an accessible cable-car, and free time for shopping and leisure. This outing followed the morning lessons about AT for outdoor mobility, leisure and sport. It was an opportunity to strengthen relationships among participants, and for many a discovery that "nature can be accessible".

In the farewell session, the trainees were issued with an attendance certificate. A general discussion was held in which each participant publicly expressed his/her views on the course. A final questionnaire was also handed out, compiled and collected. The information thus gathered was later used by the staff to evaluate not only the effectiveness of the course, but also the organisation’s general educational activity.

6.2.1. Context

Since 1979, GIHP Aquitaine (Groupement pour l'Insertion des Personnes Handicapées Physiques), an association of disabled people based in Bordeaux (France), has been running individual courses for people with disabilities who were seeking to increase autonomy in daily life. The first course was addressed to visually impaired people, and then temporary accommodation and home support services were created for people with motor impairment. Over the past few years, an accessible lodging service and a computer training service have also been added.

In order to ensure that these services were properly run, the association hired a team of skilled professionals in social and employment integration. Thanks to the impetus of the founding members, these professionals (an occupational therapist, a social worker, a psychologist, an educationalist, and an instructor in locomotion, Braille and daily living) developed considerable experience in supporting people in their daily life environment. This support has always taken into account the various complementary aspects of autonomy: psychological aspects related to either the individual or the family, socio-economic aspects, and technical aspects related to increasing autonomy in daily activities. This last element relates directly to the use of AT as a tool for autonomy. GIHP’s activities have mainly been organised around individual work focusing on individual needs and based on a co-ordinated multidisciplinary approach.

In 1998, at the behest of the EUSTAT project, GIHP Aquitaine decided to organise a course on technical aids for a group of persons with disabilities. This was a fairly novel experience for the association, joining professionals and users together in a common process.

In a similar context, ANLH (Association Nationale pour le Logement des personnes handicapées) in Brussels also undertook the organisation of a new educational initiative for end-users in Belgium. The main mission of ANLH (the National Association for the Lodging of People with Disability) is to promote the social integration of people with physical disability by providing lodging and a living environment adapted to their needs. With this aim in view, ANLH established a set of services called AVJ (Daily Life Activities), whereby persons with severe physical can opt for an autonomous lifestyle in their private lodging, supported by a personal assistance service that is on call round the clock seven days a week.

In 1998, following a request from several AVJ services, ANLH launched a training initiative for both users and staff. This had a twofold aim: to provide the knowledge and know-how that disabled persons need in order to find their own way towards independent living, both in daily life and work; and to train personal assistants in how best to support an independent lifestyle. Named EPIL, this training project received funding from the European Commission within the framework of the DG5 Employment / Horizon programme. The topics covered related to disability in general, centring on five key subjects:

• AT and accessibility
• Communication issues
• AVJ services and activities of daily life
• Legislation
• Employment.

It was decided to spread the training over five monographic seminars, each lasting one or two or three days to be repeated for three different regions: Brussels, Wallonie and Flanders. This meant that the AT module, designed on the basis of the EUSTAT model, would consist of a one-day seminar to be held in three different locations for three different groups of trainees, and in two different languages (French and Dutch). The title chosen was "From Technical Aids to Decision".

GIHP decided to dedicate this initiative solely to persons with disabilities, although it had initially been argued that it would also be useful for many others such as families, helpers and professionals, with a fruitful and enriching exchange occurring among the four groups.

A letter was sent out to 900 people who had benefited from GIHP services in the past. The letter contained the project presentation, a phone number for further information and a registration form to send back before the deadline. Applicants were also called on to specify the personal motivations for attending the seminars, so as to assess the spontaneous response to such an innovative programme.

For pedagogical reasons, it was decided to limit the number of participants to twelve, as it was believed that work with a larger group would be less efficient, particularly where practical work, tutoring or exchange sessions were concerned. A register of the applicants’ phone calls was compiled, including the kind of information asked and whether the candidate eventually registered. Two selection criteria were applied:

• personal motivation, and
• date on which the registration form arrived.

The training team included two occupational therapists, a social worker, a psychologist, two computer trainers, disabled persons and AT providers. The mix of professionals and end-users was felt necessary to ensure a range of views on AT. Some disabled persons were engaged as professionals, and others on the grounds of their role in the association. It was also felt that the contribution of the occupational therapists, the social worker and the psychologist would be indispensable, and that the computer technician was essential for computer support and the use of information and communication data. The organisers considered that direct contact and dialogue with AT providers during live testing and exhibition of materials would be extremely useful.

Analysis of training needs was the first step in operational planning. This consisted of a brainstorming session attended by AVJ co-ordinators, administrators and end-users, which confirmed that end-users:

• often had limited knowledge of workable technical possibilities;
• had difficulty in using the AT presented to them due to psychological reticence, technical difficulties or functional problems;
• did not know where to go for information, adaptations, maintenance and repairs.

As a result of this brainstorming session, a questionnaire was drawn up and sent out to every trainee, along with an invitation letter to attend the seminar. Returning the questionnaire was voluntary, and trainees were invited to share their personal experience so as to help complete needs analysis.

A set of specifications was then drafted, which identified the AT used and outlined the human environment and socio-economic elements to be covered in the seminar. This provided a guideline that the training officer could follow when planning the day’s activities, and setting pedagogical aspects, content and expected results.

The preliminary estimate for attendance was 12 people per region but no limit was set on the number of registrations; if the number of applications proved to be higher a supplementary day would be organised. The trainees were persons with disabilities, most of whom were users of AVJ services in the three regions: Brussels, Wallonie and Flanders. The event was free of charge, and ANLH provided services such as transport and personal assistance in response to the needs expressed in a special coupon that each candidate had filled in and returned. Training was also open to AVJ assistants wishing to participate: agreements with their employers were made beforehand in order to decide whether and to what degree the training session was to be considered as working time.

In order to gather the required training expertise, three specialised centres in the local area were contacted: CRET (Centre de Réadaptation), SAPH (Service d'Aide aux Personnes Handicapées, an affiliate of the Red Cross) and the LBSP (Ligue Belge de la Sclérose en Plaques). The multidisciplinary nature of the training team, including AT users, was important in order to tackle various AT-related fields. It was absolutely essential for the training to be practical, since many trainees had described themselves as having little or no experience.

At the end of the selection process, the trainee group in the GIHP course comprised ten persons ranging in age from 35 to 60, some with visual impairments and the others motor disabilities. The teaching team consisted of an occupational therapist, a social worker, a psychologist, a computer trainer, and some disabled persons and AT providers. The team was led by a training co-ordinator.

72 trainees were enrolled for the ANLH seminar: 51 persons with disabilities ranging in age from 20 to 60 with severe physical disabilities (such as tetraplegia, paraplegia, muscular dystrophy, polio and multiple sclerosis); and 21 personal assistants ranging in age from 18 to 40, all employees of AVJ services. The group of disabled persons comprised 21 from Brussels, 22 from Wallonie and eight from Flanders, while the group of personal assistants comprised nine people from Brussels, five from Wallonie and seven from Flanders. There were three trainers for each site: an educationalist and an occupational therapy from LBSP, and a service delivery expert from the Ministry of Health.

THE GIHP COURSE - PROGRAMME:

• Friday 5/6/98
• Introduction
1. trainer/trainee introduction
2. explanation of the motivations and objectives of the training programme
3. presentation of the EUSTAT project
4. self-evaluation questionnaire
• Theory 1
1. general concepts
2. definition of handicap according to the WHO definition
3. AT as a support for handicap situations and for independent living
• Theory 2
1. definition of AT
2. ISO classification
3. standard classification (ten categories)
4. AT research based on the classifications
5. information resources
• Friday 12/6/98
• Theory 3
1. choice of AT
2. individual needs
3. local resources enabling the individual to make decisions
• Practice 1
1. Presentation, demo of computer aids adapted for different impairments
• Practice 2
1. Presentation and practice with the Internet and HANDYBASE databank
• Friday 19/6/98
• Theory 4
1. half-group session in flats adapted either for visual impairment or motor disabilities
2. psychological aspects of personal autonomy within community and society
3. difference between autonomy and dependence
4. acceptance of AT
• Practice 3
1. half-group session in flats adapted either for visual impairment or motor disabilities
2. comparative testing of AT used during daily activities
3. manipulations
4. analysis of the differences between models
• Friday 26/6/98
• Theory 5
1. socio-economic aspects of AT
2. costs of AT
3. financial and legal aspects
4. funding
• Practice 4
1. half-group session organised on the basis of visual impairment or motor disabilities
2. AT demo by a supplier
• Practice 5
1. critical analysis of Practical Session 4
• Closing
1. course evaluation
2. theoretical and practical competence acquired
3. analysis of course contents
4. tips for course improvement

THE ANLH SEMINAR - PROGRAMME:

• Time: 10.00
• Introduction
1. presentation of the EUSTAT and EPIL programs
2. presentation of the EUSTAT User Manual
• Time: 11.00
• Lecture
1. presentation of a counselling service
2. the different types of professionals and when they intervene
3. legislative and financial aspects
4. traps to avoid and handy tricks
5. how can end users make autonomous choices?
• Time: 12.00
• Discussion
1. Questions & answers
• Time: 14.00
• Example
1. Two users presented their own experience in AT: history of the choice; why they chose an assistive device; problems, people and specialists encountered; finance; uses of AT; improvements gained from AT; training in AT use; whether the users would make the same decisions if they had to choose again
• Time: 15.00
• Discussion
1. Discussion of user testimony
• Time: 16.00
• Discussion
1. Seminar evaluation

Being a short initiative, the ANLH seminar is sufficiently self-explained by the programme above, but further information concerning the GIHP course might prove useful.

The GIHP programme comprised three types of sessions:

• theoretical: definitions, key words, classification, information sources, psychological and socio-economic aspects, choice procedures;
• practical: comparative tests, materials exhibition, adapted computer and introduction to the Internet;
• discussion: roundtables, case studies.

The sessions were spread over a month in order to allow trainers and trainees time for elaboration. The range of topics could have been extended with more lectures, but GIHP wished to give priority to practical sessions so as to maximise interactivity and to involve everybody actively in the work.

It was felt necessary to tackle fundamental aspects of disability definition (such as ICIDH and ICIDH-2) and to relate disability to the human, physical and community environment. AT was approached in conjunction with the concept of autonomy; AT use and the various existing classifications, especially the ISO classification, were discussed.

These concepts were also explored in hands-on sessions for various AT categories. Comparative tests were done to foster reflection about the value of each characteristic. Trainees also attended a commercial exhibition of AT tools, and discussed their relative advantages, drawbacks, limits, and appropriate use contexts. This was followed by discussion of the relationship between providers and end-users.

AT was also studied in relation to individual psychological facets, and the difficulties inherent in the process of prescription, acceptance and use of AT were highlighted. At the same time, stress was placed on how an open, tolerant and well-informed community (including the community of professionals) could foster the acceptance and use of the AT.

A large part of the GIHP course was devoted to the socio-economic dimension, involving law, costs and procedures for AT acceptance. This made it possible to discuss the economic dimensions of AT, to exchange views on the inadequacies of current systems, and to understand the differences between the existing system (thinking about the best way to use it) and what would be the most appropriate system. One of the objectives of this approach was to help trainees stick to reality and be constructive.

By associating this basic knowledge with the use of available tools, trainers and trainees built a dynamic research process. It was particularly important to identify a procedure grounded on individual, needs-based initiative that would lead to satisfactory and confident use of AT. This raised fundamental questions like:

• What are the different steps in this procedure and what are their characteristics?
• What tools can ensure a good result?

The process involved human aspects of problem solving: starting with a precise need; assessing the situation; searching for information; meeting somebody and establishing a relationship; carrying out tests and investigations; and making decisions. An inventory of existing resources was drawn up, featuring: professional know-how; user organisations; and information sources such as magazines, articles, Information & Communication Technology (ICT) and exhibitions). In addition, practice was gained in the use of information sources, especially the Internet, and through some small role-plays and simulation of real cases.

The teaching aids and educational material used during the course included whiteboard, overhead projector, videos, publications and handouts. Various methods were used to transmit knowledge on AT to disabled persons. Stress was also placed on creating a dynamic and constructive exchange so that positive effects would be produced in daily life after training. The contributions of some disabled persons who are both professionals and daily AT users contributed to get across this message. Group work appeared to be more suitable and useful than the individual work adopted in the previous training initiatives. Consequently, this course was not designed just for solving the individual’s problems, but rather to help participants situate themselves in a "meta" position in relation to AT and its daily support of autonomy. Personal testimony made a major contribution in this direction.

At the end of the course, participants were asked for their views about the course, the quality of teaching, and their personal contribution. It was interesting to see how this experience influenced individual and collective perspectives. Further evaluation was planned in the form of another meeting held six months after the course ended.

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