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					SURVEY OF ASSISTIVE TECHNOLOGY USERS’ NEEDS IN MASSACHUSETTS


Dear Survey Respondent,

                                                                        What is AT?
Massachusetts is studying the needs of people with
                                                                       wheelchairs
disabilities for assistive technology (known as “AT”). If you          communication              Formatted: Font color: Auto

are an AT user yourself, we hope you will take the time to              devices
                                                                       hearing aids
respond to this survey. If you work with AT users or have
                                                                       assistive listening
someone using AT in your family, we request your                        devices                    Formatted: Font color: Auto
                                                                       talking watches
responses as well.
                                                                       electronic aids to daily
                                                                        living
Your time on this survey will help decide how our state can            large print material,
                                                                       text-to-speech screen
make AT easier to use and more available for a wider                                               Formatted: Font color: Auto
                                                                        readers
group of people. Thank you for taking the time to complete             alternative keyboards
                                                                        and mice
this survey and helping to improve the lives of persons with           head pointing devices
disabilities in Massachusetts. Your time is appreciated.               voice recognition
                                                                        software
                                                                       screen magnification
This survey is available in foreign languages (Spanish,                 software
                                                                       adaptive toys
Portuguese, Chinese, Vietnamese, Khmer and Russian)
                                                                       adaptive learning tools
and in alternative formats: large print, Braille, and                  and much more
electronic format online (website http:// www.mrcweb.info/ATsurvey.asp) , via email or on
disk. Both foreign language and alternative formats of this survey are available upon request.
If you have any questions regarding the survey, please contact Massachusetts Assistive
Technology Act Project gram Staff at Massachusetts Rehabilitation Commission via phone
(voice) 617-204-385113 or (TTY) 617-204-3815.                                                      Formatted: Font: 12 pt




Thank you!




Before you begin, please indicate who is completing this survey.*
      I am an AT user myself                              I am a service provider of AT users   Formatted: Font color: Auto
                                                                                                Formatted: Number of columns: 2
      I am a family member of an AT userr                 I am an advocate of an AT users
                                                                                                Formatted: Font color: Auto
                                                          Other: Please                         Formatted: Font color: Auto

      I am an educator of AT users                     specify______________                    Formatted: Font color: Auto
                                                                                                Formatted: Font color: Auto
      I am a clinician of AT users
                                                                                                Formatted: Font color: Auto
                                                                                                Formatted: Section start: Continuous

Are you are completing this survey on behalf of a person with disabilities?                     Formatted: Font color: Auto

      Yes        No                                                                             Formatted: Font color: Auto
                                                                                                Formatted: Font color: Auto
                                                                                                Formatted: Font color: Auto
                                                                                                Formatted: Font color: Auto
                                    Survey of Assistive Technology Users’ Needs in Massachusetts; 2005




                                          Section I                                                      Formatted: Font: Bold

 Please answer questions in this section if you are an AT user yourself or completing
       the survey on behalf of an individual AT user. If you are not an AT User
                      yourselfOtherwise, please skip to Section II.



1. What is the your age?                                                                                 Formatted: Font color: Auto

          0 – 3 years old       4 – 22 years old        23 – 59 years old     60 years old +


2. Where do you live?
          Cape & Island         Central MA                    Greater Boston
          Northeast MA          Southeast MA                  Western MA


3. Where do you get most AT supports?                                                                    Formatted: Font color: Auto

          Cape & Island                 Central MA                          Greater Boston
          Northeast MA                  Southeast MA                        Western MA


4. What is your ethnicity?                                                                               Formatted: Font color: Auto

          African American              Asian American                      Caucasian
          Hispanic American             Native American                     Other: ____________


5. What disability best describes you?                                                                   Formatted: Font color: Auto

          Physical disability           Visual disability                   Intellectual disability
          Learning disability           Legally Blind                       Psychiatric disability
          Deaf                          Brain Injury                        Hard of Hearing
          Other: Please Specify ______
                                                                                                         Formatted: Indent: Left: 0.25", First line:
                                                                                                         0.25"
6. Do you have difficulty with the following sensory-motor function?
          Seeing                        Learning              Remembering
          Lifting                       Speaking              Walking
          Interacting with others       Thinking              Listening (auditory processing)


                                                   3
                                     Survey of Assistive Technology Users’ Needs in Massachusetts; 2005

          Hearing
          Long term emotional, psychological, or psychiatric condition
          Other:______________________________________


7. Do you work?                                                                                           Formatted: Font color: Auto

          Yes            No


8. If yYes, what is the his/heryour work status?                                                          Formatted: Indent: Left: 0", Line spacing:
                                                                                                          1.5 lines, Numbered + Level: 1 + Numbering
                                                                                                          Style: 1, 2, 3, … + Start at: 1 + Alignment: Left
                                                                                                          + Aligned at: 0.25" + Tab after: 0.5" + Indent
          Full-time    Part-time     Internship         Volunteer                                         at: 0.5", Tab stops: 0", List tab + Not at 0.5"
          Other (Please specify): ________

8.9.   What is your current living situation?                                                             Formatted: Bullets and Numbering

          Living alone                                                                                    Formatted: Top: 0.63"

          Living with family members
          Living with roommates
          Living in a group home
          Living in a nursing facility
          Living in an institution


9.10. Has your living situation changed in the last 5 years?                                              Formatted: Bullets and Numbering

   Yes           No




                                                    3
                                           Section II                                               Formatted: Font: Bold

  Please answer these questions if you are either an AT User yourself or if you have a family
               member who uses AT, or if you provide any service to AT Users.                       Formatted: Font: Bold




10.11. To what extent do you agree that AT contributes to your independence or to that of the       Formatted: Bullets and Numbering

   AT users in your family or with whom you work?
                                                Strongly   Agree   Disagree   Strongly    Not       Formatted Table
                                                 Agree                        Disagree Applicable   Formatted: Indent: Left: -0.08"

    Living independently                             4        3          2       1          0
    Working                                          4        3          2       1          0
    Participating in the community                   4        3          2       1          0
    (volunteer, religious worship, community
    events
    Learning (school, general education)             4        3          2       1          0



11.12. What are the biggest barriers that you faced in getting the right AT or that were faced by   Formatted: Bullets and Numbering

   the AT users in your family or with whom you work? (Check all that apply)
      Frustration using AT                                 Lack of training
      High cost                                            Long insurance approval process
      Lack of funding                                      Purchased wrong AT
      Lacks access to a local resource center              No barriers
      Lack of AT loaner equipment to try out for short-term
      Lack of knowledge on what AT devices are available
      Lack of skilled professionals to make good recommendations
      Other: Please specify______________


12.13. Are you familiar with the Massachusetts Assistive Technology Loan Program (MATLP)            Formatted: Bullets and Numbering

   which is a low-interest financial loan program?
      Yes                      No


13.14. If yes, how did you learn about this MAprogram Assistive Technology Loan Program?            Formatted: Bullets and Numbering

   (Check all that apply).                                                                          Formatted: Font: Not Italic

      AT workshop                                          Newsletter
                                                    Survey of AT Users in Massachusetts; 2005

      Newspaper                                          Word of mouth
      Website                                            Mass AT Toll-Free Hotline
      Local community disability-related organization
      Other: Please specify______________


14.In your opinion, what would be the ONE best strategy to further advertise the                  Formatted: Bullets and Numbering

   Massachusetts Assistive Technology Loan Program? (Check one)                                   Formatted: Font: Italic

      AT workshop                                        Newspaper
      Newsletter                                         Word of mouth
      Website                                            AT Toll-Free Hotline
      Local community disability-related organization
      Other: Please specify______________
                                                                                                  Formatted: Indent: Left: 0"

15. In your opinion, what would be the best strategy to further advertise the Massachusetts       Formatted: Bullets and Numbering

   Assistive Technology Loan Program? (Check one)
      AT workshop                                        Newspaper
      Newsletter                                         Word of mouth
      Website                                            AT Toll-Free Hotline
      Local community disability-related organization
      Other: Please specify______________


15.16. In your opinion, would a new AT Reutilization Program - that allows one to swap, repair,   Formatted: Bullets and Numbering

   recycle, or otherwise re-use various second-hand AT devices - be helpful in our state?         Formatted: Font color: Auto

      Yes                     No


16.17. Have you ever obtained AT devices from such an AT Reutilization program for yourself       Formatted: Bullets and Numbering

   or for an AT user in your family or with whom you work?
      Yes                     No (Please go to question #21)




                                               3
                                                       Survey of AT Users in Massachusetts; 2005



17.18. If yes, how satisfied were you with the following aspects of that AT Reutilization                  Formatted: Font color: Auto
                                                                                                           Formatted: Bullets and Numbering
   Program?
                                        Very        Satisfied     Dissatisfied          Very
                                       Satisfied                                     Dissatisfied
    Choice of AT devices                  4            3               2                  1
    Condition of the AT devices           4            3               2                  1
    Knowledge of the staff                4            3               2                  1
    Technical support offered             4            3               2                  1




18.19. If yes, to what extent did you find the services of that AT Reutilization program to be:            Formatted: Bullets and Numbering

                                         Strongly    Agree      Disagree    Strongly             Not
                                          Agree                             Disagree          Applicable
    Reliable                                  4        3           2             1                0
    Essential for pursuing                    4        3           2             1                0
    educational goals.
    Critical for independence in the          4        3           2             1                0
    community.
    Helpful for using                         4        3           2             1                0
    telecommunication and
    information technology.



19.20. What barriers, if any, prevented you from using an AT Reutilization Program or                      Formatted: Bullets and Numbering

   prevented its use by an AT user in your family or with whom you work?
      Lack of warranty protections                           No barriers
      Recycled AT outdated                                   No interest in second-hand AT
      Poor quality of second-hand AT                         Incompatibility with higher tech AT
   device                                                    Other:________________________


20.21. In your opinion, would an AT Lending Program - that allows individuals to borrow AT                 Formatted: Bullets and Numbering

   devices for short periods of time - be helpful in our state?
      Yes                      No


21.22. Have you ever borrowed AT devices from such an AT Lending Program for yourself or                   Formatted: Bullets and Numbering

   for an AT User in your family or with whom you work?
                                              3
                           Survey of AT Users in Massachusetts; 2005

Yes   No (Please goto question #26)




                     3
                                                        Survey of AT Users in Massachusetts; 2005



22.23. If yes, how satisfied were you with the following aspects of that AT Lending Program?            Formatted: Bullets and Numbering

                               Very        Satisfied     Dissatisfied          Very           Not       Formatted Table
                              Satisfied                                     Dissatisfied   Applicable
    Selection of devices         4            3                  2               1             0
    Condition of devices         4            3                  2               1             0
    Staff level of               4            3                  2               1             0
    expertise
    Loan period                  4            3                  2               1             0

                                                                                                        Formatted: Indent: Left: 0"
23.24. If yes, to what extent did you find the services of the AT lending Program to be:                Formatted: Bullets and Numbering

                                             Strongly      Agree     Disagree     Strongly     Not      Formatted Table
                                              Agree                               Disagree    Applica
                                                                                               -ble
    Reliable                                      4          3          2             1         0
    Essential for pursuing educational            4          3          2             1         0
    goals.
    Critical for independence in the              4          3          2             1            0
    community.
    Helpful for using telecommunication           4          3          2             1            0
    and information technology.

24.25. What barriers, if any, prevented you from borrowing from an AT Lending Program or                Formatted: Bullets and Numbering

   prevented its use by AT Users in your family or with whom you work?
      Limited AT selection                               Program already exists in my community
      Loan period too short                              Other: Please specify_______________
      No barriers


25.26. In your opinion, would a new AT Demonstration Center - that displays displays the                Formatted: Font color: Auto
                                                                                                        Formatted: Bullets and Numbering
   newest AT devices and allows people to try them out with assistance from technical staff -
   be helpful?
      Yes               No


26.27. If yes, how far would you be willing to travel to reach such an AT Demonstration Center          Formatted: Bullets and Numbering

   or how far would AT users in your family or with whom you work willingly travel?
      0 – 25 miles      26 -50 miles        51 – 75 miles            76 – 100 miles



                                               3
    Survey of AT Users in Massachusetts; 2005




                                                Formatted: Bullets and Numbering




3
                                                           Survey of AT Users in Massachusetts; 2005

27.Have you ever used such an AT Demonstration Center for yourself or for an AT User in
your family or with whom you work?
      Yes                     No


28. Have you ever used such an AT Demonstration Center for yourself or for an AT User in                  Formatted: Indent: Left: 0", Numbered +
                                                                                                          Level: 1 + Numbering Style: 1, 2, 3, … + Start
   your family or with whom you work?                                                                     at: 1 + Alignment: Left + Aligned at: 0.25" +
                                                                                                          Tab after: 0.5" + Indent at: 0.5", Tab stops:
      Yes                     No                                                                          0", List tab + Not at 0.5"
                                                                                                          Formatted: Bullets and Numbering


28.29. If yes, how satisfied were you with the following aspects of the AT Demonstration                  Formatted: Bullets and Numbering

   Center’s services?
                                      Very           Satisfied       Dissatisfied          Very
                                     Satisfied                                          Dissatisfied
    Demonstration of AT devices          4                 3              2                  1
    Expertise of Staff                   4                 3              2                  1
    Preliminary evaluation               4                 3              2                  1
    Training to use equipment            4                 3              2                  1
    Technical support                    4                 3              2                  1


29.30. If yes, to what extent did you find the services of the AT Demonstration Center to be:             Formatted: Bullets and Numbering

                                      Strongly       Agree        Disagree    Strongly          Not       Formatted Table
                                       Agree                                  Disagree       Applicable
    Reliable                             4             3             2              1             0
    Essential for pursuing               4             3             2              1             0
    educational goals.
    Critical for independence in         4             3             2              1             0
    the community.
    Helpful for using                    4             3             2              1             0
    telecommunication and
    information technology.
                                                                                                          Formatted Table



31. What barriers, if any, prevented you from using an AT Demonstration Center or prevented               Formatted: Bullets and Numbering

   its use by AT users in your family or with whom you work?
      Center already exists in my                              Centers have limited AT devices
   community                                                   Staff unequipped to address needs
      Center located too far away                              Other: ______________________
       No barriers

                                                 3
                                                      Survey of AT Users in Massachusetts; 2005



32. Please put the following proposed new AT programs for Massachusetts in order of               Formatted: Bullets and Numbering

      importance to you by ranking them from 1 to 3. (1 = the Most Important, 3 = Least
      Important)
30.         What barriers, if any, prevented you from using an AT Demonstration Center or         Formatted: Bullets and Numbering

      prevented its use by AT users in your family or with whom you work?
         Center already exists in my                    Centers have limited AT devices
      community                                         Staff unequipped to address needs
         Center located too far away                    Other: ______________________
31.         No barriers                                                                           Formatted: Tab stops: 0", List tab
                                                                                                  Formatted: Bullets and Numbering


                                                                                                  Formatted: Tab stops: 0", List tab
                                                                                                  Formatted: Bullets and Numbering




                                                 3
                                                        Survey of AT Users in Massachusetts; 2005

31.Please put the following proposed new AT programs for Massachusetts in order of
importance to you by ranking them from 1 to 3.
       __ AT Reutilization Program
       __ AT Lending Program
       __ AT Demonstration Center
                                                                                                    Formatted: Tab stops: 0", List tab + Not at
                                                                                                    0.5"



                                          Section III                                               Formatted: Font: Bold

 Please answer these questions if you are either an AT User yourself or if you have a family
                  member who uses AT, or provide any service to AT Users.



32.33. In your opinion, have you received ongoing strong support and advocacy for your AT           Formatted: Bullets and Numbering

   needs in Massachusetts or have AT users in your family or with whom you work received
   such quality assistance?
          Yes                        No


34. In your opinion:                                                                                Formatted: Bullets and Numbering

          A. What forms of advocacy are needed to improve AT services in Massachusetts?             Formatted: Numbered + Level: 2 +
                                                                                                    Numbering Style: A, B, C, … + Start at: 1 +
   ________________________________________________________________________                         Alignment: Left + Aligned at: 0.75" + Tab
                                                                                                    after: 1" + Indent at: 1"
          B. , What AT supports are difficult to obtain in Massachusetts?                           Formatted: Bullets and Numbering

   ________________________________________________________________________                         Formatted: Indent: Left: 0.25"
                                                                                                    Formatted: Numbered + Level: 2 +
                                                                                                    Numbering Style: A, B, C, … + Start at: 1 +
                                                                                                    Alignment: Left + Aligned at: 0.75" + Tab
34.35. Have there been enough AT conferences and trainings held in Massachusetts?                   after: 1" + Indent at: 1"
                                                                                                    Formatted: Bullets and Numbering
          Yes                        No
                                                                                                    Formatted: Bullets and Numbering


35.36. How frequently have you attended?                                                            Formatted: Bullets and Numbering

          None         Once a year     Twice a year          Three or more times a year


37. How often would you attend if there were more AT conferences and trainings?                     Formatted: Bullets and Numbering

          None         Once a year     Twice a year          Three or more times a year




                                                 3
                                                      Survey of AT Users in Massachusetts; 2005

38. How often each year would you likely usea toll-free hotline that answers questions about      Formatted: Bullets and Numbering

   AT?
36.How often would you attend if there were more AT conferences and trainings?                    Formatted: Bullets and Numbering

         None          Once a year     Twice a year        Three or more times a year


                                                                                                  Formatted: Bullets and Numbering




                                              3
                                                       Survey of AT Users in Massachusetts; 2005

37.How often each year would you likely use a toll-free hotline that answers questions about
AT?
          Never          1 - 3 times          4-6 times            7 – 9 times              > 10


38.39. In your opinion, how helpful would an email distribution list - that automatically          Formatted: Bullets and Numbering

   broadcasts information over the internet - be in sharing AT information amongst residents
   of Massachusetts?
          Very helpful
          Somewhat helpful
          Not at all helpful




                                                 3
                                                   Survey of AT Users in Massachusetts; 2005


39.40. Are there any other recommendations you would like to make about how                    Formatted: Bullets and Numbering

   Massachusetts can better meet the AT needs of persons with disabilities in our state?




40.41. OPTIONAL:                                                                               Formatted: Bullets and Numbering

   Name:__________________Email:________________Phone:_______________




                            Thank you for completing this survey!


Please send completed surveys to                                                               Formatted: Left

Massachusetts Rehabilitation Commission


                                              3
                                                 Survey of AT Users in Massachusetts; 2005

Independent Living and Rehabilitation Technology Department
27 Wormwood St. Suite 600
Boston, MA 02210




                                            3

				
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