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Rehabilitation - Essential Conditions

Page history last edited by PBworks 14 years, 6 months ago

Rehab - Introduction

Rehab - Challenges

Rehab - Essential Conditions


Rehabilitative non-profit organizations are part of the human service branch of the non-profit community. They are typically funded by governments (taxpayers) to provide services to folks with a range of physical or intellectual disabilities and they often receive a small portion of their operating expenses via fundraising activities which subsidize the organization.   


Although commonly known as rehab. agencies, many of the people who receive services will never be 'rehabilitated' because of the permanent and life-long nature of their disability.  


Services typically include supports to enable individuals to participate in society along with able-bodied and able-minded citizens, thereby decreasing the feelings of isolation and exclusion persons with disabilities can experience. Supports can be physical (ramps, wheelchairs, technology such as speech recognition etc.) or human (people to accompany them to community functions, support them to obtain and maintain employment, attend leisure, religious or recreational activities, or allow them to be mobile in their own homes). There are also varying degrees of skill required of caregivers, including personal expertise, the ability to administer complex medical interventions, lift and carry heavy people and equipment, and the ability to manage complex and unanticipated behaviors or situations. 


As with other non-profits, employees in the rehab sector have a range of job descriptions, and possess vast arrays of educational preparation and technological understanding to do their jobs. Altruism and people skills are commonly cited as a typical character traits of people choosing to work for non-profit organizations, while technical skills are stereotypically absent.  The question for examination here becomes how do Jacobsen's (2006) essential conditions apply to rehab non-profit organizations?   The next section explores this question in the literature and via anecdotal information and personal experience.      


Jacobsen's 10 essential conditions to adopt technology: Is there support for this position in the literature in non-profit organizations?


1 - An Executive Director or Chief Executive Officer who believes in the need for technological innovation. (NO)

Kavamoto,C., A.: Wen, C. L., Battistella, L., R., & Bohm, G., M., (2005) A brazilian model of distance education in physical medicine and rehabilitation based on vedeoconferencing and internet learning. In Journal of Telemedicine and Telecare. S1 (80-82).


This article describes a grass-roots initiative attempting to offer support for folks with disabilities across lengthy distances and with few staffing resources.

Three groups of health professionals collaborated with each other to create distance- training for folks suffering from back pain, as well as for folks requiring amputation rehabilitation. There was no leader in this scenario, but rather a collaboration of medical, educational and computer science professionals who came together based on a common need (the need to help folks with disabilities who could not easily attend rehab therapy in person due to distance, financial and physical constraints).  The training was taken by 136 participants, as well as those who function as their primary caregivers (social networks including family members). The training was judged to be successful and beneficial for patients and professionals, in spite of the lack of a person in a leadership position.   




2 - Staff who share the CEO's beliefs, and are willing to put forth the effort required to change the tasks they are comfortable performing. (YES)

As with the Kavamoto et.al. study above, the absence of the leader did not prevent this dedicated group of professionals from collaborating across different professions to meet the needs of folks with disabilities who do not have the ability to attend rehab programs in person. However in this case, it appears that staff simply have to see a need in their community, and creatively try to meet that need with existing resources. The 'leader' in this case was not a person, but a shared value or 'vision' common to 3 distinct groups of professionals who were able to see how collaborating interprofessionally could benefit folks struggling to adapt to disability within their community.  





3 - A mentor or expert each staff can learn and gain support from as their learning journey evolves.  (NO)

Leech, L. L. & Holcomb, J. M. (2004). Leveling the playing field: The development of a distance education program in rehabilitation counseling. In Assistive Technology 16(2), 135-143.


This article describes the development of a distance education program to prepare counselors to work with folks with disabilities, and it concentrates on recruiting people with disabilities to offer these counseling services. Again the design of the program appears to be motivated by grass-roots community need, rather than the availability of one person who has any special expertise to share. Aligning with constructivist methods of education, the ongoing non-hierarchica process of learning together to create a solution to a problem that wants to be solved solely motivated the creation of this program. No one was expert in the beginning, and no one will evolve as 'The' expert in the end .It is the needs of learners'  that drives the creation of the program, in the true spirit of community ed.  





4 - Technology consistently available anywhere and anytime (as the need presents itself) (Yes)

Clearly technology is required to provide training with technology, and it must be both consistently available and user-friendly when it is needed.    





5 - Time to use, discuss and process the learning (YES)

Since Knowles (1980) wrote his groundbreaking book on Androgogy, and suggested that adults require reflection and time to process their learning, other authors have replicated this finding in their own research. Pioneers in the field of Adult Education such as Schon (1984), Argyris (1974), and Kolb (1984) have each identified the requirement to use, discuss, and process new learning in context. These authors have different terms for this process; for example Schon, (1984) called it Reflection-on Action, Argyris (1974) saw it as double loop learning, and Kolb, (1984) called it reflection and abstraction (1984). All of these respected authors agree with this statement, making it my first "Requirement" for the adoption of learning technology. 





6 - Community and family support (NO)

For this point, I believe I can speak from personal experience as someone who was part of a team that successfully implemented a technological advance with absolutely no community or family support. It was the early 1990's and our job as computer trainers was to travel the province of Alberta and 'implement' a software package that was developed by the financial arm of Family and Social Services. This meant introducing computer terminals and keyboards to social workers who had never, and did not ever wish to work with any sort of machine. They were "people people", not "machine people", they had no knowledge of computers or their capabilities, and they had no conception of the positive changes possible with the adoption of this technology. Some of the older men still thought keyboarding was 'women's work' and would actively tell the trainers this. We overcame this and a great deal more over the 4 years of technological training and development in spite of having no one except the finance arm of this system on board.  As such I have to disagree with this statement given my own experiences.     






7 - Funder Support (YES)

Without funding support there can be no purchase of equipment or software, no development of programs or services, and no way to provide the expertise to the adoption of technology. As a funder, there are many types of support, however this is certainly an essential ingredient in having agencies who enjoy the choice to adopt technology of any form.  This is the second essential "Requirement" for the adoption of learning technology.  





8 - On-Site Capacity and Leadership (NO)

This 'requirement' appears redundant to both the previous sections on leadership (point one), and on the availability of an on-site expert (point three) above. Many articles describing grassroots movements (see articles quoted in the above sections) are able to describe situations where technology was adopted in spite of the fact these ingredients did not exist, there are countless examples demonstrating such conditions are not, in fact essential to technology adoption.     






9 - Interest in Innovation Spreads as New People Understand Technology's benefits (YES)

Harley, D. A., Jolivette, K., & McNall, R. (2004). Speeding up learning: Accelerated distance learning in rehabilitation education. Assistive Technology (16)124-134.
According to Hartley, Jolivette & McNall's article, the demand for accelerated distance education in the rehab field is being felt intensely in this sector given the unprecedented staffing shortages in the United States. People who serve folks with developmental disabilities are retiring at a rate unmatched by new hires, and the professional education systems are being called upon to deliver more professionally trained counselors and front line staff to meet the need (p. 124).  The authors of this article claim that accelerated distance learning produce graduates who are better prepared than their counterparts exiting the traditional programs. They suggest this is possible because of the intensity and full emersion of the student in studies, and because of their immediate opportunity to practice and use these newly developed competencies in their jobs.  
They suggest that in cases where learners learn more in less time, the amount of learning depends on student capacity, quality of instruction, personal motivation, and reinforcement through application or relationships relevant one's life (p. 126). The adoption of technology in this study appears to be driven by its ability to meet the needs of those who try it, and see it as beneficial to themselves, lending support for Jacobsen's ninth requirement. In other words, where technology has demonstrated benefits, it is quickly adopted to meet emerging needs, and adoption spreads as additional examples of its efficacy are obtained.  






10 - Technology proves itself as superior to the previous ways of doing things. (YES)

As the above article tells us, new technology in that case has proven itself superior to previous technology and therefore has created a need for itself as people strive to solve the human service problems outlined . I believe without this inherent superiority clearly observable to others, there would be no motivation to change from the previous way of doing things. The folk wisdom "If it ain't broke, don't fix it" would apply, and no one would seek to improve on things that work well as they are. Given current staffing shortages have never been encountered so keenly before, and the technological advances have been tried and proven beneficial, it holds much promise to change and adopt it. Indeed the authors of the study are advocating for its adoption, and backing up Jacobsen's final condition required to adopt technological change.      



In Conclusion, this article has taken Jacobsen's 10 essential conditions to adopt technology, scrutinized each condition, and disproven 4 out of 10 of the conditions based on additional articles cited, personal examples described, or logic employed. There are, based on this analysis, only six essential conditions here. They are: 


1. Time to use, discuss and process the learning;

2. Technological availability

3. A risk-taking culture

4. Funding support

5. Interest spreading as innovations demonstrate their efficacy and

6. Technology ultimately proves itself more beneficial than previous methods.


Based on the argument presented above, Jacobsen's position may be modified to suggest the 10 'essential' conditions are in fact 'ideal' conditions. Furthermore, unless each condition adds a unique construct to the argument, the 9th condition should be dropped from the list. 


This author would also suggest that Jacobsen has neglected the key essential ingredient that recurs in non-profit literature (and perhaps in the education literature as well). It can be variably described as altruism, care and support for others, or the 'collective will' to improve the lives of fellow citizens. In the non-profit area (and perhaps in all human service fields) this difficult-to-describe, yet essential condition appears to almost universally appear as motivator for technological adaption, given its promise to improve the health, education or life condition of various segments of the population.       


To conclude, this article suggests the original assertion should either be modified to include five 'essential' conditions, or modified to include ten 'ideal' conditions to adopt technology.   


Sally Perry-MacLean (November, 2007)

Summary of conditions


The 10 conditions for technology adoption and sustainability of Library 2.0


Not Essential

1. Strategic Leadership


2. Learning Risk-taking culture

3. Mentoring  

4. Reliable Technology

5. Time for review/sharing

6. Community support  

7. Funder support

8. On-site capacity  

9. Diffusion of interest

10. Technology proves itself as superior (Resistance is futile)


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