Feature Issue on Employment and IDD
Using Technology to Support Employment
Two graduate assistants at the Minnesota Robotics Institute, Haoyi Shi (right) and Haoyuan Du (left) explain how the Nao robot interacts with humans as part of a collaboration between ICI and the Department of Computer Science & Engineering.
Technology, including the use of robotics, is one of the key solutions to the severe shortage of qualified direct support professionals (DSPs). DSPs are using remote home monitoring and assistive technologies to help with daily living tasks and rehabilitation services. New robots, including FoldiMate and Grillbot, can fold clothes and cook food. Robotics can aid DSPs by freeing up time for interacting directly with people they support. Socially assistive robots are used to help people with daily living tasks and as companions supporting well-being and psychological health. They have been used for research and as test models in supporting older people, but we need more studies to learn how they work for people with intellectual and/or developmental disabilities (IDD). Nearly half of the states are working on plans or laws that prioritize technology as a way to overcome staff shortages, support the autonomy of people with disabilities, and reduce costs. Researchers at the University of Minnesota’s Institute on Community Integration and its College of Science and Engineering are exploring the use of socially assistive robots equipped with artificial intelligence.
People with intellectual, developmental, and other cognitive disabilities depend on the disability services infrastructure to live and participate in their communities, including the provision of day-to-day supports with health and hygiene, transportation, employment, and leisure activities. High turnover and vacancy rates in direct support professional (DSP) positions can, however, significantly interfere with a person’s ability to live and work in home and community-based settings, as noted in a 2020 article in Intellectual and Developmental Disabilities.
A just-published scoping review in Inclusion discusses the ongoing shortage of qualified workers across disability service systems, and this costly turnover poses difficulties in establishing positive organizational culture when many staff leave their positions with less than one-year tenure.
Recruiting, retaining, and training DSPs to meet community support service needs for people with IDD and other cognitive disabilities has been an issue since the deinstitutionalization movement for people with IDD began in the 1970s.
“Along with the acknowledgment of the importance of direct-care staff has come a growing concern for the abnormally high rates of turnover among people occupying these positions” early leaders at the Institute on Community Integration wrote in a 1981 report .
To accommodate more people with IDD living in small community settings, the total number of residential service settings increased dramatically over the last 30 years. In the community, DSPs are expected to support a high quality of life for the people they support. This includes the achievement of person-centered goals and opportunities for self-determination, social and community inclusion, and full and active community participation, according to competency standards highlighted by the National Alliance for Direct Support Professionals. Direct support staff often encounter various psychological challenges, including an increased risk of work-related stress and anxiety; burnout and feelings of depersonalization; and irritation and emotional exhaustion, as described in a 2003 Journal of Advanced Nursing article .
Needed: Technology-Based Solutions
Given the clear relationship between high-quality services and supports, including the presence and quality of DSPs, and the inclusion and participation of people with cognitive disabilities in the community, there is a critical need to address the current workforce crisis the service system is experiencing. Technology, including socially assistive robotics (SAR) is one of the key solutions to this workforce crisis.
Various types of technologies have been implemented as aids in organizations and homes to assist DSPs who support adults with IDD and aging needs at different levels, including home monitoring and automation, assistive technology, and telehealth. Robotics is an emerging technology that consists of automated devices that assist in rehabilitation and/or daily living skills and increase efficiency. FoldiMate and Grillbot, for example, help fold clothes and grill food without assistance. Robotics can aid DSPs by freeing up time for direct engagement with people supported and can also provide more options for self-management and independence. During the COVID-19 pandemic, robots became even more sought after in residential and employment settings as they were not susceptible to illness, were easily disinfected, could assist with health screening and monitoring, and were able to assist with engaging people with disabilities in activities, as noted in a 2021 Robotics article .
Assistive robots can be described based on two categories, rehabilitation robots (assistive robotic devices) and socially assistive robots (SARs). Socially assistive robots can be divided in two subtypes, service-type robots and companion-type robots. The service-type robots are used to assist the person in daily activities, such as eating, bathing, and getting dressed. Companion SAR Workforce robots are used to support psychological well-being and health. Several types have been used for research or as prototypes for supporting mostly people with aging needs, including Nao and Pepper, which have a humanoid structure and can be AI-programmed, as noted in IEEE Access. Nao and Pepper have been used across several studies, have shown preliminary evidence of usability and feasibility and participant engagement, and can be purchased.
While there is a developing body of preliminary research on SARs targeting older adults with promising findings, there is only a handful of published studies targeting people with IDD.
As people with and without disabilities are living longer and economic resources for support staffing are inadequate, we must seek new, ethical solutions to support person-centered living in the community. To support this effort, 22 states have established initiatives or legislation towards making their states a technology-first state, meaning that technology solutions should be sought right from the start. The three states to have official Technology First legislation are Minnesota, Missouri, and Ohio. Technology First prioritizes technology in supporting autonomy, overcoming staff shortages, and cost effectiveness.
One of the potential solutions utilizes artificial intelligence (AI). Examples of AI in the workplace include speech recognition software, virtual assistants, social assistive robots (SARs), and collaborative robotic systems, as discussed in this year’s published proceedings of the 17th International Conference on Pervasive Technologies Related to Assistive Environments. With interactive AI in the workspace, the scale in which the AI itself has no autonomy or full autonomy is dictated by the users themselves. AI having no to little autonomy can serve as assistive technology while reducing the fear of fully autonomous AI in the workplace. The ethics of assistive technology, including AI, involve enhancing autonomy in various facets of one’s life, including the workspace, not to simply do all of the work for the individual.
AI-Powered Socially Assistive Robot at the University of Minnesota and Udac
Researchers at ICI in collaboration with the University of Minnesota’s College of Science and Engineering (MN Robotics Institute) have been exploring the use of SAR equipped with AI to interact with people who are aging. The initial project titled Enhancing Physical Activity Among Older Adults Using Nao, a Socially Assistive Robot (SAR) was funded through a CEHD Jump Start seed grant. In this project the researchers worked with The Pillars, an assistive living organization in Minnesota, to find out how aging adults with mild cognitive challenges reacted to the SAR and the extent to which the robot was able to initiate and follow individual interactions. The preliminary findings suggest that the SAR could serve as a companion for some people with aging needs with providing practical advice and companionship, thus relieving their staff in ways that they can focus on the needs of residents with which the SAR is unable to assist.
Following in the steps of using AI-powered SAR, Karen Herman and her team at Udac in Duluth, Minnesota, in collaboration with ICI and the MN Robotics Institute, has recently received a grant from the Minnesota Department of Human Service to use Nao to support people with IDD in the workplace. This will be the first study of its kind to use Nao in this capacity. The project is based on the principle that SAR will work with and for the individual – designed to address their unique challenges and provide person-centered or tailored support. This personalization may be in several areas – interaction and social skills, emotional support, task sequencing, reminders and time ques, job specific information and other needed support. It has the benefit of providing more autonomy and self-sufficiency with communication assistance, tailored support for learning and supporting educational needs for the job, and emotional support and companionship. To do this, SAR must be adapted and programmed to the diverse and unique needs of the individual.
These transformative companions have great potential to address workplace barriers and reduce or eliminate the need for long-term job coaching. The ultimate goal is to inspire independence, confidence and to promote empowerment to allow the persons served to be successful in their employment role.