DSPs Using and Supporting Technology Use
Technology Solutions 2.0 Survey: Examining Technology First Systems Change Before and After the Pandemic
Gloria Gantt, author
What Are the Technology Solutions and What Is Tecchnology First Systems Change?
Technology First began as a movement emphasizing people’s access to technology support. Today, Technology First has transformed into a “framework for systems change where technology is considered first in the discussion of support options available to individuals and families through person-centered approaches to promote meaningful participation, social inclusion, self-determination, and quality of life” (Tanis, 2019). Putting Technology First into practice requires efforts on several levels. The levels are pictured on the circular diagram called the Evaluation of Technology Systems Change (see image ).
Evaluation of Technology in Systems- A diagram with three nested circles representing the levels of system evaluation. The innermost circle is labeled micro, the next big circle is meso, and the largest outermost circle is macro. State DD Agencies and Public Policy point to Macro (circle in dark purple). Service Providers and Organizations and Agencies point to Meso (circle in medium purple). Individual points to Micro (circle in lighter purple). Logo for State of the State has 15 red stars with in a dark blue circle, and inside the that is the center of the circle with image of the USA including Alaska and Hawaii. Inside the image of the continental US is a bar graph that indicates increasing.
Evaluation of Technology in Systems
The diagram shows that there are three levels where change is needed to be effective:
- Micro: occurs with the individual in clinical assessment and support
- Meso: organizations and agencies involved in assessment and professional support delivery
- Macro: planning incorporating the societal perspective in policy
Supporting Technology First will require changes in individual, agency, and policy-level supports. Technology First's system changes also need a way to evaluate the changes at every level. The State of the States has partnered with ANCOR to assess the meso level. In 2021, they released the Advancing Technology Access for People with IDD report, surveying service providers and organizations that employ direct support professionals (DSPs). ANCOR and the State of the States are currently working on a second iteration of this report. The 2019 Technology Solutions State Survey and its successor, the Technology Solutions 2.0 Survey, tracks the changes at the macro level by surveying individuals working at state agencies. This was done in partnership with the National Association of State Directors of Developmental Disability Services (NASDDDS) network.
How Did It Start?
The vision for the original Technology Solutions report, launched in 2019, came from a discussion about Technology First Systems Change. How could Technology First enhance quality support for people with intellectual and developmental disabilities (IDD)? The first Technology Solutions Survey aimed to evaluate how Technology First Systems Change could be utilized with people with IDD in mind. More specifically, understanding how to provide extra support through technology use that addresses each Core Quality of Life Domain and Indicator (see image ).
Core Quality of Life Chart- A blue and white diagram that breaks down Core Quality of Life Indicators into eight groups: Emotional Well-Being, Interpersonal Relations, Material Well-Being, Personal Development, Physical Well-Being, Self-Determination, Rights, and Social Inclusion.
Level 1 Emotional Well-Being, Contentment, self-concept and lack of stress. Level 2 Interpersonal Relationships, interactions, relationships and supports. Level 3 Material Well-Being – Financial status, employee and housing. Level 4 – Personal Development – Education, personal competence, and performance. Level 5 Physical Well-Being – Health and health care, activities of daily living and leisure. Level 6 Self-Determination – Autonomy, personal control and personal values, and choice. Rights – Human (respect, dignity, equality) and legal. Level 7 Social Inclusion – Community integrations and participation, community roles and social support. Buntix W. & Schalock R. (2010) Models and Disability. Quality of Live, and Individualized Supports Implications for Professional Practice in Intellectual Disabilities. Journal of Policy and Practice in Intellectual Disabilities. 7 (4) p. 283-294.
Seven Levels of Indicators of Quality of Life
The Technology Solutions 2.0 Survey
After the COVID-19 pandemic, NASDDDS and the State of the States project launched the second Technology Solutions State Survey. We renamed it the Technology Solutions 2.0 Survey. In addition to some of the original pieces of the survey, the Technology Solutions 2.0 Survey looked at how the pandemic had changed access and resources for people with IDD. The survey investigated three main items: (1) Funding for Technology Solutions, (2) Service or Operational Specifications, and (3) Benchmarking for Technology First Systems Change. Thirty-nine states and the District of Columbia completed the survey, but the lack of participation did not indicate a lack of investments in technology solutions. Who filled out the survey? The NASDDDS network contacted each State Director of Developmental Disability to identify a staff member in organizations who was knowledgeable in tech-related services and supports. Below are brief summaries of key findings in the 2023 Technology Solutions 2.0 Survey report.
Increased Funding for Technology Solutions
In the original 2019 Technology Solutions National Survey, Home and Community Based Services (HCBS) Waivers were identified as the primary funding sources for technology. The 2023 survey highlighted increased state investments in diverse technology and funding, including grants and loans. In 2023, there was a notable increase in the use of non-HCBS Waiver funding sources, including state general funds and vocational rehabilitation funds.
The COVID-19 pandemic also provided temporary funds like the American Rescue Plan Act (ARPA). The State of the States project examined technology-related investment categories outlined in state spending plans for the use of ARPA funds. With these funds, 49 states invested in technology solutions, enhanced infrastructure, or supported specific devices, all of which increased technology adoption. The data from the survey reflects this broader and more diverse approach to funding and supporting technology solutions for people with IDD. Ongoing investments and pilot programs demonstrate a shift towards sustained technological integration.
Differences in Service or Operational Specifications
The IDD field is often criticized for using jargon and acronyms. Jargon and acronyms can complicate the understanding and adoption of services, especially in IDD services, where new technologies must be clearly defined for policy and funding. We documented this in the 2023 survey. Different states define new technologies such as "remote supports." While the term "remote supports" was commonly used across state agencies, definitions varied widely. We found that the term “remote supports” covered aspects like service delivery, goals, and equipment. Common elements included live two-way communication and equipment like web-based monitoring. Definitions also differed regarding health and safety focus, equipment specifics, and eligibility criteria.
Additionally, "telehealth" was the broadest term used. “Telehealth” offered flexibility in hardware and program delivery, whereas other terms like "virtual" and "remote" emphasized specific service delivery methods. Understanding these variations can help future policies refine definitions to improve consistency, evaluate technology use, and address service gaps across states.
Benchmarking for Technology First Systems Change
Lastly, the 2023 survey assessed state progress in Technology First Systems Change. The survey focused on statewide policy initiatives, implementation frameworks, and data-driven decision-making. States varied in integrating technology into health and human services. While many states are working towards Technology First standards, challenges remain. Technology use among individuals with IDD still needs statewide evaluation. The number of states providing training for technology use grew by 50%. Still, most states wanted more technical assistance to evaluate people’s technology needs.
Our survey also highlighted that only six states reached expert status in the Technology First Systems Change Model based on legislative priorities or specific programs . Thirteen other states were advancing technology policies, 16 were not, and 11 were unsure of their progress. More positively, many states achieved the key benchmark of incorporating technology into Individual Service Plans (ISP) or Person-Centered Service Plans (PCSP). Ohio, among others, provides resources and guidance on supportive technology.
Why Is it Important?
Historically, technology solutions in the IDD field have been investigated for their ability to advance a person’s autonomy and self-direction. As technology use becomes more important for community integration and for organizations to run smoothly, the DD service system must adapt to update policies, research, programs, and practices to keep up with technological innovation.