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Joy Zabala was deeply proud to have been a part of the field of education for more than forty years. She was a universally respected pioneer in Assistive Technology (AT) and eventually joined the staff at CAST to concentrate on accessible educational materials and Universal Design for Learning (UDL) and their relationship to AT. She was an internationally active conference presenter, a co-founder of Quality Indicators for Assistive Technology (QIAT), and the creator of The SETT Framework, utilized throughout the world.

The SETT Framework is a four-part model (Student, Environments, Tasks, Tools) which promotes collaborative decision-making in all phases of assistive technology service design and delivery.

This site provides information about Joy and her work, and support materials related to the SETT Framework and to QIAT, UDL, and AEM.

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Joy Zabala was deeply proud to have been a part of the field of education for more than forty years. She was a universally respected pioneer in Assistive Technology (AT) and eventually joined the staff at CAST to concentrate on accessible educational materials and Universal Design for Learning (UDL) and their relationship to AT.

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Quality Indicators for Assistive Technology Services

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Welcome to the QIAT website, the official site of the QIAT Community. This website supports QIAT's mission of guiding the development and delivery of quality assistive technology services by providing the QIAT Community with a gateway to resources.

The QIAT Community is a nationwide grassroots group that includes hundreds of individuals who provide input into the ongoing process of identifying, disseminating, and implementing a set of widely-applicable Quality Indicators for Assistive Technology Services in school settings that can be used as a tool to support:

school districts as they strive to develop and provide quality assistive technology services aligned to federal, state and local mandates

assistive technology service providers as they evaluate and constantly improve their services

consumers of assistive technology services as they seek adequate assistive technology services which meet their needs

universities and professional developers as they conduct research and deliver programs that promote the development of the competencies needed to provide quality assistive technology services

policy makers as they attempt to develop judicious and equitable policies related to assistive technology services.

Closing the Gap Conference

The Joy Zabala Fellowship for Assistive Technology and Accessible Educational Material

The 2023-2024 Joy Zabala Fellowship pairs are:

Dr. Aaron Marsters (mentor), an Assistive Technology Instructional System Specialist for the Department of Defense Education Activity in Europe, and Jayme Grant (mentee), an Educational and Assistive Technology Specialist in the Beaufort County Schools in Beaufort, South Carolina, will work to increase educator and leadership capacity to implement effective and data-driven AT consideration and implementation processes at high-risk K-12 schools.

Darla Ashton (mentor), an Instructional Interventionist Coach in Indiana, will work with Candace Hayden (mentee), an AT Specialist in Texas, to increase understanding, skills, tools, and resources in AT and AEM, improving procedures for providing thoughtful consideration of AT in primary and secondary schools.

Dr. Danalyn Workentin (mentor), an Occupational Therapist and AT Professional in Florida, will work with Megan Stewart (mentee), a Speech Language Pathologist at a school in Florida, to facilitate a school-based AT team while building AT knowledge with families and staff.

Celebrate and ensure Joy's legacy, please make your tax-deductible gift to the Joy Zabala Fellowship today!
All donations go directly to the Joy Zabala Fellowship to support the activities of the mentorship partners. CAST, a 501(c)3 charitable organization, serves as the fiduciary agent of the Fellowship. CAST and the QIAT Leadership team donate their time and administrative support to the Fellowship.
Mail donation checks payable to CAST, Inc. Please note Joy Zabala Fellowship on the check and mail to:

Joy Zabala Fellowship Fund, c/o CAST, Inc. 50 Salem Street, Bldg. B, Suite 103, Lynnfield, MA 01940 781-245-2212 (voice) 781-245-5212 (fax)

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Home - Quality Indicators for Assistive Technology Services

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Welcome to the QIAT website, the official site of the QIAT Community. This website supports QIAT's mission of guiding the development and delivery of quality assistive technology services by providing the QIAT Community with a gateway to resources. The QIAT Community is a nationwide grassroots group that includes hundreds of individuals who provide input into [...]

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The UDL Guidelines are a tool used in the implementation of Universal Design for Learning, a framework to improve and optimize teaching and learning for all people based on scientific insights into how humans learn. Learn more about the Universal Design for Learning framework from CAST. The UDL Guidelines can be used by educators, curriculum developers, researchers, parents, and anyone else who wants to implement the UDL framework in a learning environment. These guidelines offer a set of concrete suggestions that can be applied to any discipline or domain to ensure that all learners can access and participate in meaningful, challenging learning opportunities.

Reenvisioning the UDL Guidelines

Because the UDL Guidelines are meant to be informed by feedback from the field as well as new research, they have been updated several times in the past. We are in the process of updating the Guidelines once again in our UDL Rising to Equity initiative.

This update will focus specifically on addressing systemic barriers that result in inequitable learning opportunities and outcomes. CAST aims to develop a transparent, inclusive, and community-driven process. If you are interested in collaborating and staying updated on our progress, we invite you to complete a brief survey.

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The UDL Guidelines are a tool used in the implementation of Universal Design for Learning, a framework to improve and optimize teaching and learning for all people based on scientific insights into how humans learn. Learn more about the Universal Design for Learning framework from CAST. The UDL Guidelines can be used by educators, curriculum developers, researchers, parents, and anyone else who wants to implement the UDL framework in a learning environment. These guidelines offer a set of concrete suggestions that can be applied to any discipline or domain to ensure that all learners can access and participate in meaningful, challenging learning opportunities.

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https://www.theudlproject.com/udl-tools---all-grades.html

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The UDL Implementation Rubric was authored by Melissa Toland, and you can read more about it here. This is an adapted version of The UDL Progression Rubric by Dr. Katie Novak and Dr. Kristian Rodriguez. In the original version, teachers can self-evaluate their performance on each individual checkpoint of the UDL guidelines, whereas the adapted version is less specific in scope and focuses on performance in more general terms in the following areas: multiple means of engagement, multiple means of representation, and multiple means of action and expression. You can view this rubric to see where you may be in your UDL journey across a spectrum ranging from UDL explorer to UDL idol. Click the link below to download the pdf version of this document.

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CAST UDL Guidelines The two files below outline the UDL guidelines by multiple means of representation, multiple means of action & expression, and multiple means of engagement. Knowing the UDL...

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Abstract

Abstract
Background and Methods: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit.

Findings: Key concepts addressed include a person-centred team approach; sustainability indicators to monitor, measure, and respond to needs for service design and delivery; education, research, and training for competent practice, using the six rehab-workforce challenges framework; and credentialing frameworks. We propose development of a competence framework and associated education and training programs, and development and implementation of a certification framework for AT personnel.

Conclusions: There is a resolve to address the challenges faced by People globally to access assistive technology. Context specific needs assessment is required to understand the AT Personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements.

Implications for Rehabilitation

Personnel in assistive technology (AT) provision should be trained using a person-centred team approach, which emphasizes appropriate skill-mix to address multiple needs within the community.

Sustainability indicators should be used which allow personnel to monitor, measure and respond to needs for service design and delivery.

A competence framework with associated education and training program, coupled with the development and implementation of a certification framework for AT personnel needs, will promote quality in AT personnel training globally.

Part A: assistive technology personnel context

Introduction

The United Nations "Convention on the Rights of Persons with Disabilities" (CRPD) requires governments to meet the assistive technology (AT) needs of citizens [ 1]. To achieve this requirement, Member States need to undertake a needs assessment and progressively work towards enacting legislation, developing policies, procurement and provision systems, building work-force capacity, and promoting AT product availability and advancement, through stakeholder engagement in research, education and training.

Furthermore, Tebbutt et al. illustrate how the achievement of each of the 17 sustainable development goals (SDGs) can be facilitated using assistive products [ 2]. They argued that "without promoting the availability of assistive products the SDGs cannot be achieved equitably [ 2]". Tebbutt et al. highlight how assistive products are considered both a mediator and a moderator of SDG achievement. To this end, the World Health Organization (WHO) recognizes the importance of access to assistive technologies, as evidenced by the recent adoption of Resolution EB142.R6 (improving access to AT) by the World Health Organization Executive Board, [ 3] the World Health Assembly resolution WHA 58.23, [ 4] and the WHO Global Disability Action Plan 2014-2021 which called for Member States to improve access to AT [ 5].

Usage of AT is widely recognized as enabling people to carry out activities of daily living, and enjoy full citizenship through their participation in domains of life including economic, political, social, cultural, spiritual, religious and leisure [ 6-8]. As an example, a recent systematic review with meta-analysis found AT supported adolescents and adults with learning disabilities achieve better educational outcomes, increased satisfaction with learning, and improved quality of life [ 9].

Access to AT is challenging internationally, particularly for people in lower resourced environments, where only 5-15% of people who require AT have access to it due to multifactorial reasons including a shortage of skilled professionals [ 10]. Even in high resource countries, people living in low income households experience significant barriers to accessing AT. Poor planning and commissioning, limited initiatives, leadership and governance in relation to AT services are associated with a lack of information and/or education and training available to persons who require or provide AT [ 11]. A survey of experts specializing in AT found that respondent countries reported an average 29% of the capacity to implement planned services [ 12]. It is widely acknowledged that significant workforce shortages exist in many contexts, which is a major barrier in meeting the needs of people requiring AT. In fact, countries with the highest prevalence of disability-related health conditions tend to be those with the lowest supply of health workers skilled in provision of AT (as low as two professionals per 10,000 population) [ 13].

A multi-disciplinary workforce in a health system is often required to meet AT needs. The recent WHO publication Rehabilitation in Health Systems [ 14] suggests that multi-disciplinary rehabilitation can be effective in managing chronic, complex or severe conditions. Based on the high level of evidence, they recommend that a multi-disciplinary workforce should be available, "as different rehabilitation disciplines require specific skills" (p.8) [ 14]. However, multi-disciplinary workforces may be burdened by high barriers such as cost and availability of qualified personnel, or lack of integration resulting in inefficient service delivery. Planning provision and service impact requires exploration of specific contexts, gleaning an understanding of the place, people, pace and policy required to build a sustainable community of practice, utilizing sustainability indicators to monitor, measure and respond to the AT provision process [ 15, 16].

This paper reviews the current capacity of human resources in enabling access to AT as well as the systems and processes within which they function, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit. We propose a sustainable approach as the way forward for human resources development to meet the AT needs of every citizen.

Part B: challenges in the current personnel approach for at provision

In high resourced environments, there are clearly established professions who act as AT personnel, including, but not limited to, occupational therapy, physiotherapy, speech and language therapy, and physical and rehabilitation medicine. Within each of these professions, AT provision often comprises a part, but not the whole of the profession's focus. Additional professional groups including prosthetists/orthotists, rehabilitation engineers and AT professionals may focus directly on AT service provision. In these contexts, work within a multidisciplinary team provides opportunities for task shifting, with the appropriate mix of knowledge and skills to achieve AT related outcomes.

Often, AT personnel are trained in a single area of expertise (e.g., visual, hearing, mobility products), and focus on assessing for and providing a specific AT solution. This may contribute to having too many AT specialists and not enough general rehabilitation practitioners, particularly in higher-resourced contexts. In lower-resourced countries, nonspecific rehabilitation professions or other health workers may be responsible for the provision of AT services. It is important to identify the optimal mix of generalists and specialists to achieve identified outcomes in each context, supported by adequate training for skilled personnel, and opportunities for continuing education to allow increased specialization for cases of higher complexity.

Many people require a range of AT products and services from multiple sources to meet their specific needs. As AT is provided across multiple sectors, it becomes increasingly complex and requires collaborative multi-disciplinary approaches [ 17, 18]. Where government agencies are responsible for providing AT, various services are generally planned and procured (commissioned) independently from one another, often by different departments or organizations, with limited collaboration with other sectors and agencies. Given the heterogeneity of populations, a greater understanding by those planning and commissioning services is required. The avoidance of unnecessary overlap among personnel will promote a more integrated approach. There is a need for coordination of services, as well as skill-mix among the human resources charged with the provision system.

AT services are at risk of not being truly person-centred, as individuals' AT needs are rarely planned for or assessed coherently [ 19, 20]. Current delivery models for most AT services tend to be reactive (i.e., a product or service is put in place after something happens), with relatively little focus on prevention, as it is difficult to provide evidence on whether an outcome has been prevented. It is usually the immediate (often clinical) rather than anticipatory need that is considered. For example, an individual with a complex progressive condition like multiple sclerosis may receive services which address immediate needs for mobility and fatigue management, without consideration for future AT needs for self-care, maintaining employment, and other activities of daily living. AT services often have a focus on assessment and prescription, without robust and consistent systems in place for evaluating if individual goals have been achieved throughout the process, from referral to follow-up and management [ 21].

Often wider issues are not considered, including the environment where the product is to be used, and the role of care providers. This is complicated by little focus on innovation and continuous improvement in the provision process, as providers are often guided by detailed and prescriptive specifications, imposed by payers who have little incentive to fund cutting edge AT services and products. As a result, duplication in administration, assessment, and procurement results in disjointed provision, and increases service-related costs.

While examples of models and standards of best practice service provision processes exist, e.g., CECOPS Standards, there is a lack of role clarity regarding the personnel involved [ 22, 23]. Two examples demonstrate the importance of priority products and the potential personnel involved.

(1) Visual assistive products - low vision is attributable to "...serious consequences in almost all aspects of human life: moving around, caring for oneself, social interaction, education, employment, leisure. Without vision, the world (the natural world and urban world) suddenly becomes less accessible [ 23]." The type of priority assistive products (APL) required and skill mix of personnel involved to meet the "obstacles faced by individuals" of all ages will vary, given the graduation of visual acuity from mild visual impairment to total blindness with no light perception [ 23, 24]. Individuals involved in the design, assessment and provision of visual products include a number team members, for example: persons with vision loss, ophthalmologists, orientation and mobility specialists, education and rehabilitation professionals (occupational therapists, psychologists, physical and rehabilitation medicine physicians), computer engineers [ 23].

(2) Posture and wheeled mobility assistive products - the WHO (2008) "Guidelines on the Provision of Manual Wheelchairs in Less Resourced Settings" acknowledges the importance of providing an appropriate wheelchair as a basic human right, describing an eight step process for service delivery [ 25]. Wheelchair and seating AT (WSAT) is a primary need, described as "An enabler both extrinsically and intrinsically for people ...posture and mobility impairments...to actively participate across their life span in everyday living. The type and complexity of the WSAT provided will depend on the limitations and restrictions caused to individuals" ...to personally participate within their desired environment and context [ 26]. The guidelines include the stakeholders directly involved in the service delivery process [ 27] for example users, families and carer providers, government authorities, health and rehabilitation services, supporting organizations rehabilitation personnel, wheelchair service personnel [ 25]. These guidelines have been utilized in research to assess the delivery process within context [ 28]. Inconsistencies exist in low and lower middle-income countries, for example, with disparities found regarding education and training of personnel involved, with no clear indicators regarding who is responsible for oversight of the provision system [ 29].

People using AT services should be empowered with the right knowledge, information and safeguards in place, to make informed decisions, with more choice and control to manage their health care, and wellbeing with respect to their AT needs.

It is the shared responsibility of personnel to work in collaboration with people using AT services to improve coordination and communication, remove organizational barriers, and achieve best outcomes. AT systems should be developed with focus on prevention, ensuring the use of evidence-based policies and strategies, to strengthen systems, promote sustainability, and meet the diversity of needs in a timely and appropriate manner.

A skill-mix approach rather than specific staff type within a health workforce can facilitate the delivery of person-centred health care services [ 13, 30-32]. A personnel solution which addresses basic skills for AT provision for all service providers, with specialization for cases of increased complexity, may have the potential to mainstream AT provision in wider health and social care services, reaching a larger part of the population. Formal and non-formal education pathways represent an opportunity to develop capacity among those who are not normally engaged in rehabilitation and AT provision (i.e., physicians, physician's assistants, nurses, nurse practitioners, AT users, caregivers). In addition, there are opportunities to support, develop and establish local educational programs that are both contextually relevant and culturally sensitive, diversifying the workforce required for successful implementation of AT systems [ 33].

Part C: context-aware personnel development and training using a skill mix and task-shifting approach

Developing sustainable processes and service delivery models is complex and challenging, given the diversity of people, products and personnel involved globally [ 2, 34]. Appropriate infrastructures are required when planning, providing and evaluating AT service [ 21]. Focusing specifically on skills necessary to develop sustainable infrastructures requires consideration of country specific dimensions, and the already available professional resources. There is a need to build personnel capacity for individuals and/or teams to provide appropriate AT, with multiple professions involved as prescribers, producers, payers and policy makers [ 35]. In addition, personnel responsible for oversight, procurement, commissioning, provision and evaluation of AT services, require adequate education and training to enable appropriate AT systems to be realized [ 36]. It is also important to highlight the need for the community and other related professionals to have a basic understanding of the importance of AT for improving lives, as a non-collaborative environment may reduce the effectiveness of any specific intervention [ 37]. This capacity building and professional development should foster a lifelong learning perspective to accommodate the rapid pace of change in both technology and society at large [ 38].

A primary challenge to address, when considering specific personnel needs, is the understanding and use of the term "assistive technology". For example, in areas of rehabilitation, education, research or policy development the type of AT can vary depending on the context, and assistive product required.

Definitions of AT, assistive products (AP) and priority assistive products (APL) presented by the WHO [ 39] are in Appendix A. AT products may replace body function and structures or optimize functioning by restoring, augmenting and compensating body function or body structure impairments [ 40]. Drawing from a number of sources [ 23, 24, 41], it is also possible to categorize the WHO APL [ 39], into four groupings: daily living, communication, sensory, personal mobility and further divide into sub-groupings which may assist with planning for services and personnel required (see sample classification in Appendix B). Using this approach may allow the development of specific competencies and areas of practice, for example around posture and wheeled mobility or daily living products.

The development of a core set of baseline competencies in each of the priority assistive products, followed by specialization and advanced training in product groupings may help to address the needs of people with increasing complexity, and provide avenues for continuing education of personnel, and the application of best practice provision evidence. A systematic approach to personnel education and training ( Figure 1), which acknowledges the need for basic competence across a range of devices at the community level, followed by specialization of personnel in product groupings, will contribute to a provision system which can be modified and adapted to local contexts. This will ensure meeting the greatest need for basic devices within communities, while allowing individuals with higher levels of need to be seen by personnel with additional specialized education and training. Using this model, all practitioners are responsible for generalist practice, while specialist services are located centrally within the broader context.

Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology

A new skillset is also required across planning, procuring and service delivery systems. This skillset must address the challenge of interoperability, where some priority assistive products are compatible and can be integrated; for example, when a person requires the use of apps, communication devices, environmental controls and a wheelchair. Furthermore, it is important to recognize that while the APL represents a range of AT prioritized for global provision, service providers should be prepared to address AT outside the confines of such a list.

The development of appropriate skill mix across a range of potential providers may help to alleviate the lack of service integration and oversight, overcome challenges of overloaded personnel, and avoid rigid systems which cannot meet individual and context specific needs. In each context, a thorough needs assessment, with robust epidemiological data, will allow the development of the appropriate mix of skills and professionals to advance AT practice and provision processes. Furthermore, gathering information regarding the complex and varied needs of people who use AT, will allow for continuous learning systems, aimed to improve accountability, efficiency and quality [ 42, 43]. Understanding an individual's personal requirements is an important factor for determining needs, and respective resource use across a range of assistive products [ 43].

To achieve appropriate skill mix requires the development of new staffing models where certain tasks are "shifted" from those with specialist training to those with generalist training [ 44]. Task shifting aims to increase the workforce to enhance services, while lowering costs. By reducing the amount of education required, it can be considered an effective approach to overcome the issue of shortage and unbalanced skill-mix among health professions [ 30, 44]. Evidence on task shifting in a variety of domains shows this approach may be more cost effective and offer higher quality care than a physician-centred model [ 45], and can effectively deliver a number of specific interventions. These include preventive interventions for maternal and child health, stroke recovery tasks, and management of chronic conditions such as asthma, hypertension, diabetes, epilepsy, anxiety and depression [ 46-49]. Rehabilitation assistants, have gained recognition recently in higher resourced settings, demonstrating the potential to alleviate burden within the rehabilitation system, and serve as a good example of how tasks may be shifted to those with shorter or more generalist training [ 50].

Community-based rehabilitation (CBR) was introduced by the WHO as a strategy to increase access to rehabilitation and was strengthened by the publication of the guidelines for CBR [ 10]. The guidelines strongly encourage the training of alternative cadres through curricula which targets specific contextual needs [ 44]. Assistive technologies are acknowledged within the CBR guidelines as an essential component. Specifically, the guidelines suggest community health workers should be knowledgeable about the function and application of assistive devices, including basic fabrication and maintenance, while being aware of community resources, including potential funding [ 10]. Furthermore, the guidelines state that people who require access to rehabilitation and their families should be included in this learning process [ 10]. Community health workers have long since been considered the key to address the lack of rehabilitation facilities in underserved areas. CBR personnel may represent an opportunity to address the AT needs of citizens given the widespread presence of CBR programs around the globe [ 10, 51]. In CBR, the extent of the human resources that are needed for adequate health care necessitates new thinking about what sort of personnel and training is most likely to be effective. A systematic review of CBR staff concluded "research is needed on the training, performance and impacts of rehabilitation workers, including their capability of working across sectors and engaging with and making use of health systems research [ 52]". A comprehensive job and skills analysis is needed in order to retain clinical effectiveness and patient's safety [ 52].

The context often has a determining influence on the outcomes of interventions [ 53]. In some instances, people may be discouraged from accessing health services due to the prejudicial attitudes they experience from health professionals [ 54, 55]. Alternative personnel may be considered more acceptable at the community level. In one study, community health workers delivering maternal and child health interventions were appreciated for their kindness, availability, accessibility, non-dogmatic approaches and respect [ 56]. A range of AT personnel with appropriate skillsets who work in community settings can play a role in overcoming such barriers. In order to be effective, task shifting procedures should be framed within health policies and receive recognition by the country's health system [ 30]. Moreover, alternative cadres' role should be clearly described, as well as the tasks they are expected to undertake.

Key considerations

Several key principles are considered here when developing a sustainable strategy for AT provision, which must be understood and put into force by all personnel engaged in the entire AT provision process.

Person-centred team approach

Assistive technology provision requires a team approach with individual people requiring AT at the centre of the process when making decisions regarding assessment, procurement and overall service delivery. This person-centred team approach is critical at all stages of the AT process, beginning with the design of AT to meet the user's actual needs. It is expected that personnel working across all areas of AT provision will have sufficient knowledge, skills, abilities and attitudes necessary for person-centred design, procurement, delivery, and evaluation of AT products and services, regardless of their level of specialization or generalist backgrounds [ 57].

Person-centred AT provision hinges on the provision of client-centred service provision, working together in the development of priority assistive products and systems for provision. Six key concepts are considered in client-centred care: individual autonomy, partnership, provider and client responsibility, enablement, contextual understanding, accessibility and respect for diversity [ 58]. These key concepts must be understood and applied by all personnel involved in provision of AT, maintaining the person and their needs/goals at the centre of the process. A review of models and instruments used in the selection and provision of AT found that, despite a lack of evidence-based procedures for AT provision, most of the available models and instruments client-centred [ 59].

The principles of user-centred design also suggest a need for user involvement early in the design of both technologies and systems [ 60]. People using AT are typically aware of their own needs, including environmental limitations, and may participate in co-creation to ensure more beneficial design [ 61]. The inclusion of AT use experience and ideas in the development and evaluation of medical and assistive technologies can improve design interface, function, and quality of devices [ 62, 63]. Furthermore, this increases the likelihood the end product will be suitable for use by the person within the context, thereby increasing the likelihood of adoption [ 61].

Sustainability indicators to monitor, measure and respond to needs for service design and delivery

A lack of guiding principles regarding structures and processes relating to organizational responsibilities makes it difficult to both evaluate and improve the overall quality of services provided. The absence of clear guiding principles also leads to ambiguity around roles and responsibilities, causing a lack of clarity around service expectation for the individuals' using services and those providing services, and confusion among government and private insurance payers.

Having sustainability indicator based quality frameworks (e.g., CECOPS) which include methods of monitoring, measuring outcomes and standards for procurement and provision of services, would provide a common baseline, and a benchmark against which organizations could respond for continuous improvement [ 16, 64]. This in turn could be evaluated by others such as government and private insurance payers, not only based on outcomes but also efficiency of service provision processes. Education and training on any such sustainability indicators would then give individuals, organizations and sectors a clearer understanding of roles, responsibilities and required outcomes for sustainable development.

Education, research, and training for competent practice

To address a person-centred skill mix team approach, allowing for sustainability safeguards in design and service delivery of priority assistive products, education, research and training for competent practice is essential. Adapting the six rehab-workforce challenges [ 65] provides a structure to identify the central elements required to conduct research, develop competency and practice criteria required for AT personnel (see Table 1).

Local institutions of higher education and training (IHET) are ideally situated to equip current and emerging AT personnel to meet the six rehab-workforce challenges and assist with realizing the CRPD and SDGs in relation to AT personnel. Universities or IHET are primarily responsible for the generation and translation of knowledge and can potentially contribute in four areas namely: (1) conducting research, (2) revision of curricula, (3) equipping current AT personnel and (4) developing accredited training modules for non-profession AT personnel.

1. Conduct research (addressing challenges 1, 3 and 6): The first workforce challenge "To establish personnel requirements to account for the need and demand of assistive technology" can be addressed by research conducted by faculty and post-graduate students in the different fields of rehabilitation studies. This may focus on generating an overall understanding of the roles of the specific personnel involved in AT assessment and provision, including the potential role of the person requiring AT in the provision process. Furthermore, the impact of training different cadres of AT personnel can be evaluated, while maintaining a focus on local initiatives, or internationally developed solutions which may be adapted to local contexts.

2. Revision of current education and training curriculum for emerging health professionals (addressing challenges 2, 3, 4 and 5): Inter-professional education (IPE) has become an integral component of most health-professionals' training. A module or component on AT should be included in the IPE content for all rehabilitation professionals. For example, all rehabilitation professionals should be educated and evaluated in providing training to people requiring AT as well as community volunteers, through methodologies including case studies which highlight the complexity of AT provision. The importance of an interdisciplinary and multidisciplinary approach to AT assessment and practice in resource poor and rural settings should be highlighted in education programs.

3. Engage with and equip current health professionals working with AT (addressing challenges 3, 4 and 5): Most IHET who educate health professionals work in close contact with local clinicians. If the need is identified, post-graduate education and training workshops for clinicians who work with AT can be conducted with additional resources provided for train the trainer programs provided. This can potentially enhance the required skill mix for effective and appropriate AT provision.

4. Develop formally recognized/accredited education and training modules/courses for nonprofessional cadres of AT personnel (addressing challenges 1-5): Local IHET can develop formally recognized or accredited education and training modules and courses for non-formal AT personnel, with a clearly defined scope of practice. If the education and training is formally recognized and/or accredited, it is more likely that staff will be retained for a longer period. It will also enable task shifting to reduce personnel workload in areas with severe staff shortages.

5. Develop contextually relevant credentialing frameworks for professional cadres of AT personnel (addressing challenges 2, 5 and 6): Credentialing frameworks. Credentialing frameworks may address each of three levels: individual personnel, personnel education and training, and service delivery, including planning and commissioning.

At the individual personnel level, AT competency or outcome-based frameworks define the knowledge, skills, attitudes and professional competencies required for different levels of service and levels of responsibility within the AT provision process. Competency based frameworks identify specific skillsets required for the performance of AT personnel, including necessary outcomes to be achieved to demonstrate competency. Outcomes-based frameworks offer flexibility in terms of how something can be achieved, and have a broad application across different settings and environments. They are less prescriptive in terms of absolute requirements, and the specific skills needed, allowing the individual or group to be innovative. Outcomes-based frameworks are safeguarded by being incorporated into wider and comprehensive, auditable quality indicators. The Rehabilitation Engineering and Assistive Technology Society of North America (RESNA; www.resna.org) and International Association of Accessibility Professionals (IAAP; www.accessibilityassociation.org), and CECOPS ( www.cecops.org.uk) have developed examples of competency based and outcome-based credentialing frameworks respectively, which may be linked to national qualification systems [66 ]. Additional frameworks could be developed for specific areas of technology [67 ]. These frameworks would be coupled with education and training programs to address the specific needs of new and existing AT personnel.

To address the needs for personnel knowledge and training, and to mainstream AT learning in existing education and training systems, similar certification frameworks could be developed to accredit or recognize educational programs for AT personnel. The Council on the Accreditation of Allied Health Education Programs (CAAHEP) recently approved an accreditation standard for AT education programs which addresses the skill mix of instructors, training approaches, and training content to address specific needs of individual personnel [66 ]. While this specifically addresses AT personnel needs in a high-resourced context, these standards may provide a framework for developing similar accreditation standards which are flexible and allow for context-dependent training programs to take shape. Accreditation or recognition for education programs ensures a standard is met in the knowledge and skill of personnel, which can be monitored and evaluated over time. Furthermore, education standards define outcomes associated with specific competencies, or skillsets which are deemed to be critical to role performance and continual professional education for trained personnel.

In addition, credentialing for service delivery processes must be considered, as individual personnel must work within a service delivery context. These protocols should cover the planning, commissioning, service delivery and clinical and technical aspects of services. For example, CECOPS provides support tools to enable organizations to monitor their compliance with the outcomes and drive continuous improvement. CECOPS also provide training to all groups involved in AT with content driven by the outcome-based framework.

Part D: Way forward

This position paper was reviewed, discussed and refined during and following the GREAT Summit. During this discussion, two specific areas of action emerged as a way forward when addressing personnel needs for AT provision.

Development of a competence framework and associated education and training programs

There is an identified need to establish a set of process and skill-based competencies for AT provision personnel, assuring individual needs are met in specific contexts. It is important to approach the overall provision process from a sustainability perspective, including service planning and commissioning, as well as oversight for services, not simply on building competence with specific technologies.

A focus on building competence in the provision process, from access to services and assessment, to follow up and management, will allow the workforce to continue advancing skills to keep up with the pace of ever changing society and technology.

The development of a matrix of competencies/skills related to various groupings of AT products, at varying degrees of depth would facilitate development of education and training programs which can be locally tailored and include existing programs and professional roles. A scalable competency matrix, with levels of skill proficiency, will best meet the needs of both high and low-resourced countries, in planning and executing education and training programs and certification. This could be developed through the use and evaluation of best practice case studies which address the skill mix required, to meet a range of individual needs, to allow health systems to apply best practice findings in a contextually relevant way.

Where overlaps exist between groupings of AT products, competencies should include skills in referral and collaboration, or use of skill mix in the local context. This set of core AT provision competencies will need to include those competencies required by both clinical and technical staff, as well as any other individuals responsible for planning and executing AT services or related processes, including service oversight and continuous evaluation.

Contributors to this position paper call on the WHO to establish a working group to develop a competency framework which is internationally relevant, yet can be adapted to context-specific needs.

Development and implementation of a certification framework

Although education and training may lead to individual certification, this is a second priority as compared to development of competency-based training programs to address skill mix necessary for AT provision. As countries or regional groups look to develop certification for AT provision, they may look to established schemes which are in place in other jurisdictions.

Furthermore, certification may apply to individuals, provision systems or training programs. With the understanding that certification is necessarily linked to infrastructure in each context, these may serve as a source of inspiration, rather than seen as roadmaps to specific outcomes for each country. The WHO has an opportunity to define a basic level certification threshold which addresses specific and contextual needs for certification, based on those which already exist [ 25, 68], and recognizes the unique and dynamic nature of populations and national contexts. Contributors to this position paper call on the WHO to establish a Certification Working Group to continue this discussion beyond the scope of the GREAT summit.

There is a resolve to address the challenges faced by people globally to access AT. Context specific needs assessment is required to understand the AT personnel landscape, to shape and strengthen credentialing frameworks through competencies and certification, acknowledging both general and specific skill mix requirements. These actions to address and support personnel capacity building, taken in concert with others across the five GATE areas of focus on people, provision, policy and products, will contribute to increased access to appropriate assistive products and services globally, and ensure the realization of rights for all people who require assistive technologies.

1. Establish personnel requirements to account for the need and demand of assistive technology [ 12].

2. Structural improvement to classify specific competencies and practices, and related training needs according to specific contexts and technologies [ 10, 22, 59-68].

3. Generate an understanding of the whole assistive technology workforce [ 12] at all levels of the service, to include those specific professionals: occupational therapists, physiotherapists, physicians specializing in physical and rehabilitation medicine, assistive technology professionals, rehabilitation engineers, prosthetists/orthotists and other professionals in the specific context.

4. Develop and deliver education and training and outreach supports (tele-services, coaching) valuing prior existing competencies.

5. Meet context specific requirements of personnel.

6. Develop international solutions which can be tailored locally, including existing learning programs in AT, competence frameworks and certification schemes.

Daily Living

Communication

Sensory

Personal Mobility

Self-care/Domesticlife/Cognition

Augmentative andAlternativeCommunication

Access to ICT

Visual

Auditory

AmbulantMobility

Prosthetic &Orthotic

Posture andwheeled mobility

Acknowledgements

We are very grateful to the many participants in the GREAT summit who provided stimulating discussion points, some of which have been included in this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

References

UN General Assembly. Convention on the rights of persons with disabilities. Treaty Ser. [Internet]. A/RES/61/1:3. Available from: http://www.refworld.org/docid/45f973632.html

World Health Organization Executive Board. Resolution EB142.R6 improving access to assistive technology. Geneva, Switzerland: World Health Organization; 2018.

Federici S , Scherer MJ. Assistive technology assessment handbook. Rehabilitation science in practice series; 2012. p. xxii, 446 pp.

Cook AM , Polgar JM. Cook and Hussey's Assistive Technologies: Principles and Practice technologies: principles and practice. New York: Elsevier Health Sciences; 2015. 592 pp.

World Health O. Guidelines on the provision of manual wheelchairs in less resourced-settings. Geneva: Switzerland; 2008.

Gowran RJ. Building a sustainable wheelchair and seating provision community - meeting people's primary needs now and in the future. Limerick: University of Limerick; 2012.

McSweeney E , Gowran RJ. Wheelchair service provision education and training in low and lower middle income countries: a scoping review. Disabil Rehabil Assist Technol. 2017. Epub ahead.

Health W. Priority assistive products list: improving access to assistive technology for everyone, everywhere. Geneva: World Health Organization; 2016.

Olsson E. What active users and designers contribute in the design process. Interact Comput. 2004;16:377-401.

Committee on Accreditation Rehabilitation Engineering and Assistive Technology Education (RESNA-CAAHEP). Standards and guidelines for the accreditation of educational programs in assistive technology [Internet]; 2016. Available from: http://www.caahep.org/CAAHEP/media/CAAHEP-Documents/AssistiveTechnologyStandards.pdf

World Health O. Guidelines for training personnel in developing countries for prosthetics and orthotics services. Geneva: World Health Organization; 2005.

Appendix A. Glossary of key terms

Assistive technology (AT) is the application of organized knowledge and skills related to assistive products, including systems and services. Assistive technology is a subset of health technology.

Assistive products (AP): Any external product (including devices, equipment, instruments or software), especially produced or generally available, the primary purpose of which is to maintain or improve an individual's functioning and independence, and thereby promote their well-being. Assistive products are also used to prevent impairments and secondary health conditions.

Priority assistive products (APL): Those products that are highly needed, an absolute necessity to maintain or improve an individual's functioning and which need to be available at a price the community/state can afford.

Appendix B. Sample priority AT product groupings

Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology

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Enabling appropriate personnel skill-mix for progressive realization of equitable access to assistive technology

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Abstract Abstract Background and Methods: This paper reviews the current capacity of personnel in enabling access to assistive technology (AT) as well as the systems and processes within which they work, and was reviewed, discussed, and refined during and following the Global Research, Innovation, and Education in Assistive Technology (GREAT) Summit.

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ERIC - EJ1061020 - Universal Design for Learning (UDL) and Learners with Severe Support Needs, International Journal of Whole Schooling, 2015

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This article presents the Universal Design for Learning (UDL) framework as one way to understand how to support learners with severe disabilities and how to support their access to authentic and appropriate curricula that improves their quality of life. Two key ideas from the UDL framework, (a) unde…

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Abstract

Universal Design for Learning is not widely used in postsecondary STEM education. The purpose of this literature review is to synthesize the empirical literature using Universal Design for Learning in postsecondary STEM education for all learners. The criteria for this review are (a) empirical literature in (b) peer reviewed journals (c) published after 2006. Keywords used were STEM, UDL/UDI/Universal Design, and postsecondary/university/college/higher education. This review identified four studies and three literature reviews that met the search criteria; the analysis of the identified literature provides a model for how Universal Design for Learning can impact postsecondary STEM instruction, including an increase in inclusive teaching methods and self-advocacy from students with disabilities, and leads to recommendations for additional research.

Introduction

Nationally, fewer than 40% of undergraduates who intend to major in a STEM (science, technology, engineering, math) field complete a STEM degree (Olson and Riordan, 2012). Economic projections point to the need for an increase in the number of STEM degrees produced nationally (Olson and Riordan 2012). Many students with disabilities (SWD) are capable of completing STEM degrees and achieving STEM careers. However, many qualified students drop out before completing their college degrees, and individuals with disabilities represent an undertapped population in STEM (Stamp et al., 2014). Diverse learners are capable of becoming talented professionals in STEM, but they need opportunities to develop (Roberts 2010).

SWD have increased opportunities to attend postsecondary institutions (Newman et al., 2011). At 2-year and community colleges, SWD are significantly more likely to enroll in STEM majors compared to students without disabilities (SWoD) (Lee, 2011) demonstrating an interest in STEM careers that does not currently result in equal representation. Surprisingly, in light of the reverse trend in the population of SWoD, low-income SWD are more likely to select STEM majors, possibly to increase their chances of securing employment, as individuals with disabilities are employed at a much lower rate (18.28%) compared to individuals without disabilities (63.82%) (Lee, 2014). However, Newman et al. ( 2011) reported based on the National Longitudinal Transition Study-2 (NLTS2) that less than 66% of students with disabilities enrolled in any 4-year program actually complete the program within 6 years (SRI International, 2002). Completion rates between disabilities also fluctuated. Approximately, only 38.8% of students with Autism completed their postsecondary education (Newman et al., 2011).

Large universities (i.e., > 20 k students) often present all undergraduates in STEM fields with an array of institutional barriers that can be difficult to overcome. These obstacles can be compounded for students with disabilities (SWD) who may struggle with large class sizes, fast pace of instruction, lack of scaffolding in the curriculum, precision of the content, and the pedagogical approach from STEM faculty (Street et al., 2012). Traditional institutional reform efforts focus on system-level changes in instructor behaviors and supports. However, current institutional reform efforts have not had an immediate wide-scale impact on the attrition rate of STEM majors (Basham & Marino, 2013). Universal Design is a promising strategy to support SWD, which emphasizes multiple ways of presenting curriculum to engage all learners (Basham & Marino, 2013).

A review of literature in 2011 on Universal Design in postsecondary education suggested UDL in postsecondary education is lacking a significant research base (Roberts et al., 2011). This systematic review of empirical literature will investigate research involving Universal Design in higher education and how UDL is implemented in postsecondary education for STEM majors to help retention and persistence of students with disabilities.

Universal Design's roots in architecture

The term "Universal Design" (UD) was coined in 1988 by architect Ron Mace and his colleagues at North Carolina State University (Fig. 1). Mace defined "Universal Design" as "the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design" (ACCESS Project, 2011, p. 1; U.S. Department of Housing and Urban Development, 1988). As architects, Mace and his colleagues were interested in designing buildings and roadways accessible to the entire public, including those with disabilities (College of Design, N. S. U, 2008). A familiar example of UD is the sidewalk "curb cut," which allows individuals with mobility disabilities to more easily transition from a sidewalk in to the roadway. While designed to meet the needs of individuals with disabilities, these curb cuts also improve the experience of individuals pushing strollers, bicyclers, and many others. Table 1 provides the seven principles Mace's group developed to guide Universal Design in architecture in addition to the principles designed for learning and instruction.

Table 1 Universal Design models and their principles

History of CAST and Universal Design for Learning

In 1984, Anne Meyer, David Rose, Grace Meo, Skip Stahl, and Linda Mensing from the North Shore Children's Hospital in Massachusetts created the Center for Applied Special Technology (CAST) with the goal of using technology to enhance learning for students with disabilities in grades K-12 (Center for Applied Special Technology 2011). CAST has become a leading authority on adopting the principles of UD for education, through Universal Design for Learning (UDL). Instead of focusing on accommodations for students with disabilities, UDL provides a framework to change the actual learning environment (Fovet et al., 2014). CAST's seminal paper introduced the three principles of UDL: using multiple means of representation, expression and action, and engagement (Basham & Marino 2013). Representation provides varying methods for learners to perceive information. Expression and action provides students options for planning and performing content-specific tasks. Engagement provides opportunities for students to stay involved and motivated in their learning (Center for Applied Special Technology, n.d.). The 3 principles are further described by 9 guidelines and 31 specific checkpoints.

In 2008, the Higher Education Opportunity Act provided the first statutory definition of UDL as "a scientifically valid framework for guiding educational practice that- (A) provides flexibility in the ways information is presented, in the ways students respond or demonstrate knowledge and skills, and in the ways students are engaged; and (B) reduces barriers in instruction, provides appropriate accommodations, supports, and challenges, and maintains high achievement expectations for all students, including students with disabilities and students who are limited English efficient" (U.S. Department of Education, 2008, p. 103). Additionally, the Higher Education Opportunity Act included guidelines for implementation in postsecondary settings and preservice teacher programs. CAST continues to build on the concept that UDL should focus on changing content and curriculum, not students. To this ends, CAST ( 2011) has developed a number of resources, such as the "UDL on Campus" website, providing postsecondary educators resources for making the classroom accessible to all students; the UDL curriculum toolkit, a web-based platform for developing web-based curricula and content based on UDL ( http://udl-toolkit.cast.org/home); Universal Design for Learning: Theory and Learning, a multimedia book summarizing a decade of research and practice (Meyer et al. 2014); and a variety of free learning tools aimed at educators, parents, and students ( http://www.cast.org/our-work/learning-tools.html#.WNv7yVXyuUk) (Center for Applied Special Technology, 2011).

Universal Design in Postsecondary Education

The majority of research relating to UDL has been conducted in the K-12 education setting (Rao et al., 2014). In 2001, researchers at the University of Connecticut expanded on the Universal Design for Learning (UDL) and created the nine principles of the Universal Design for Instruction (UDI) to aid faculty in the postsecondary setting in increasing access to curriculum for diverse learners (Rao et al., 2014). As shown in Table 1, UDI retains the seven principles from UD in architecture and adds two principles specific to the educational setting. Universal Instructional Design (UID) is a third commonly used framework for applying UD in postsecondary education, derived from Chickering and Gamson's principles of food practice for undergraduate education (Chickering & Gamson, 1987; Higbee & Goff, 2008).

All students learn in many different ways, whether they have a disability or not. Postsecondary courses designed with UDL and include technology applications provide all students with multiple ways to access the curriculum (Izzo and Bauer, 2015). Students without disabilities also benefit from a UDL classroom the same way students with disabilities benefit. They are able to be more engaged and motivated and have a greater interest in their own education (Ralabate, 2011). UDL has provided a framework that challenges the idea of a "one-size-fits-all" way of learning. Diversity in classrooms is more than students with disabilities versus students without disabilities. UDL continues to make learning accessible to all students (Edyburn, 2005).

Universal Design is still in its early stages of development in the educational setting (Basham & Marino, 2013; Rose et al., 2006). Rose et al. ( 2006) recognizes the distance between research and application of UDL in secondary settings and theory. Presence of UDL in graduate education is rare (Rose et al., 2006).

Results of prior literature reviews

Roberts et al. conducted a 2011 literature review on UDL in postsecondary education, using the following criteria for their search: (a) empirical studies in peer-reviewed journals; (b) published 2000 or later; and (c) use of UDL, UDI, UID, and UD in postsecondary, college, university, and higher education. Their review identified just eight studies, as shown in Table 2, indicating a lack of research in the effectiveness of UDL in postsecondary settings (Roberts et al., 2011). Most articles focused on student and faculty perspectives of UDL or training preservice teachers and faculty members to implement UDL. Roberts et al. (2011) found the research lacked studies using quantitative methods and studies exploring technology aligned with UDL. Based on these findings, Roberts et al. recommend that future research "operationalize the principles of UDI and investigate its impact on the outcomes of postsecondary education students with and without disabilities" (p. 5).

Rao et al. ( 2014) conducted a broader review in 2014, focusing on both Pre-K-12 and postsecondary UD educational models (Rao et al., 2014). They used the following inclusion criteria (a) empirical studies; (b) conducted in Pre-K-12 or postsecondary education; (c) referenced UDL, UDI and/or universal instructional design (UID); and (d) published in peer-reviewed journals. Rao et al. ( 2014) identified 13 studies, of which five were at the postsecondary level and only two used quantitative methods. Results of the two employing quantitative methods indicated an increase in student performance when UDL principles were implemented. In the first study, Schelly, Davies, and Spooner ( 2011) indicated an increased willingness of instructors to implement UDL in their lessons and an improvement in students' perceptions about how the instructors enacted the principles of UDL (presented information, engaged students, allowed student to express comprehension) after instructor training. The second study by Spooner, Baker, Harris, Ahlgrim-Delzell, and Browder ( 2007) indicated an increase in preservice teachers' ability to design lesson plans aligned with UDL after a 1-h training, compared to a control group.

Seok et al. ( 2018) conducted a study to review UDL principles in postsecondary education for students with and without disabilities. They reviewed 17 empirical studies, using the following parameters: (a) participant information, (b) courses and delivery mode, (c) independent and dependent variables, (e) implementation strategies, and (f) effectiveness of implementation. The results of the literature review showed 15 studies with effective strategies using UDL in the postsecondary setting. Each study used some aspect of the Universal Design framework. The findings of this literature review reinforce the need to provide multiple means of representation, expression, and engagement in all coursework. Students with and without disabilities benefit from the use of the UDL framework.

While researchers have conducted reviews on literature on Universal Design (Rao et al., 2014; Roberts et al., 2011; Seok et al., 2018), the literature reviews do not provide a systematic review of UDL in STEM fields. Rao et al. ( 2014), Roberts et al. ( 2011), and Seok et al. ( 2018) conducted systematic literature reviews to articulate current status and future direction for UDL from Pre-K-12 to postsecondary institutions regardless of academic subjects or disciplines. This literature review will fill the gap in relation to UDL in postsecondary STEM programs.

Prior literature reviews

Prior literature reviews are listed in Table 2.

Table 2 List of literature reviews on UDL

Purpose of the study

This literature review seeks to synthesize the existing literature on UD in postsecondary education, specifically for STEM majors. We addressed one question in our literature review: What quantitative and/or mixed methods, empirical research has been done on using the UDL framework in postsecondary STEM majors for students with disabilities?

Method

We searched five databases, cataloging empirical liteature on education, psychology, and science: EBSCOhost to search ERIC, ProQuest, Science Direct, Web of Science, and Sage Publication. The following keywords were used: STEM, UDI/UDL/UD, and postsecondary/college/university/higher education; articles published before 2006 were excluded in order to include only recent research. We used Boolean search terms (AND, OR) in order to limit our searches. We narrowed the identified article set (initially 1202 articles) to UDI/UDL in postsecondary STEM education of students with disabilities. We focused on empirical literature, defined as studies employing an experimental or quasi-experimental design, and mixed methods research to identify the impact of UDL on postsecondary STEM education; thus, we excluded editorials, rejoinders, qualitative analysis, and meta-analysis. As shown in Fig. 2, our final analysis yielded just four studies using quantitative and/or mixed methods to explore the impact of UDL on post-secondary education.

Number of peer-reviewed articles found on STEM-based key terms

Review of research

UDI/UDL in education

The list of UDL articles is shown in Table 3.

Table 3 List of UDL articles

Results

Spooner et al. ( 2007) explored the effects of professional development on including UDL principles into lesson planning and how it affected student's performance in class. Seventy-two graduate and undergraduate students participated in the study at a southeastern university. The participants in the study were enrolled in the following courses: (a) General Curriculum Access, (b) Instructional Planning of Lesson Plans, (c) Middle-Grade Science Methods, and (d) Middle-Grade Math Methods.

Students were randomly placed in either the control or the experiment group by pulling names from a hat. The intervention consisted of a 1-h lecture on UDL and how to incorporate the principles into a lesson plan to include all students in the lesson (the control group received the UDL lesson after the posttest). Students then had to construct their own lesson plans based on a case study provided to them with a student with a severe cognitive disability. The control group had business as usual. The posttest consisted of a new case study in which both groups had to construct a lesson plan utilizing the principles of UDL. A 6-point scoring rubric was used to grade the lessons. A 3-factor ANOVA with repeated measures was completed for each of the dependent variables. Statistically significant effects were found for the total pretest and posttest. The treatment group saw increased means in both general and special educators between their pretest and posttest. The control group did not find an increase in the mean scores from pretest to posttest.

The authors provided an hours' worth of instruction in UDL planning improves lesson-planning skills. Teachers who thought they were restricted by time and a lack of instruction made improvements in their planning skills to include UDL components which would include students with disabilities in their lessons.

Street et al. ( 2012) investigated the effect of training small group leaders in Universal Design on the utility of Peer-Led Team Learning (PLTL) for students with learning disabilities and/or ADHD taking introductory chemistry and calculus courses. PLTL is a popular academic support model in higher education where junior- and senior-level students who excelled in courses lead small group study sessions focused on strengthening students' collaboration and problem-solving skills. Prior data indicated that SWD did not get the similar boosts in their academic achievement from PLTL as their peers without disabilities. Street et al. ( 2012) trained experienced PLTL leaders in UDI and investigated the impact of the revised model, Mastery PLTL (MPLTL), on small groups of exclusively SWD. The researchers used both quantitative and qualitative measures, including variables such as course GPA, cumulative GPA, STEM persistence data (registering for STEM classes in the next semester), pre- and postintervention scores on the Learning and Study Strategies Inventory (LASSI), and a course evaluation. The study did not include initial GPA scores, and as a result, the researchers could not make a comparison on student growth. Sixteen students participated in the study across two semesters.

Peer mentors attended a 1-day orientation workshop and weekly 1-h seminar on UDI and participated in weekly hour-long sessions focused on training them to present information in ways more accessible to students with information-processing and/or attentional needs. Additionally, they attended 1-h weekly preparation sessions with the PLTL mentors to review the week's problems. MPLTL leaders created written and video-based "templates" based on a UDI principle, which were defined as "any tool or strategy that enhances students' understanding, retention, or application of course concepts, formulas or procedures" (Street et al., 2012, p. 367).

The intervention did not result in a statistically significant difference between the comparison groups based on average course and cumulative GPA. In the first semester, SWD who participated in the MPLTL sessions had the lower course GPAs compared both to SWD who did not participate in MPLTL and all students. In the second semester, MPLTL students outperformed non-participating SWD in chemistry, but not calculus, where all SWD outperformed the general population. Two students were disqualified to continue in their STEM major after the study due to academic ineligibility. However, the other 14 students had a higher rate of persistence (715) compared to non-participating SWD (61%). The LASSI showed significant improvement in all three focus areas, including skill, will, and self-regulation. MPLTL students found the intervention to be helpful in providing strategies to study and perform better on assignments.

Moon et al. ( 2011) published recommendations for evaluating programmatic interventions aimed at improving postsecondary STEM education for SWD and included preliminary findings from SciTrain University. SciTrain University combines in-person workshops to inform faculty about disabilities and working with SWD, with a focus on using accessible pedagogy in large lecture classes, laboratories and online learning environments, and online courses to support use of project resources at external institutions. The evaluation employed mixed-methods, including demographic and performance data for students enrolled in SciTrain courses and classroom observations and faculty online journal reflections to determine the efficacy of training given to faculty members from two different universities (Moon et al., 2011). Fifteen faculty members from Georgia Tech and University of Georgia participated in the study, though it was noted retention of members was difficult. Student GPAs were tracked for 2 years. While preliminary analysis of students' course-by-course grades did not indicate an improvement in student performance, SWD reached their goals of course completion and passing grades. Classroom observations indicated an increase in accessibility for SWD, including improvements in class note takers, oral communication, visual aids, and electronic learning support. Journal reflections showed an increase in the application of UDL strategies in trying to make better class materials and using different teaching methods to engage all students in the lessons (Moon et al., 2011).

Kreider et al. ( 2018) researched the benefits of the Comprehensive Support for STEM Students with Learning Disabilities (CS ³LD), a campus-based framework for supporting students with disabilities. The CS ³ LD model supports students with learning disabilities (LD) at three different levels, institutional, personal, and interpersonal. At the institutional level, experts in LD were employed while the personal and interpersonal supports were simultaneously offered. Support for academics included career support and mentorship. The model also focused on the student's health and well-being.

Kreider et al. ( 2018) utilized a mixed-methods design for their 4-year project. Qualitative data consisted of focus group discussions, participant communications, and individual interviews. Quantitative data came from survey and implementation data, including the Academic Behavioral Confidence Scale (ABCS), the Institutional Integration Scale (IIS), the Personal Growth Initiative Scale (PGIS), and survey questions. The researchers used a one group pre/posttest approach. The goal of the project was to analyze "model implementation, implementation outcomes, and potential for institutional adoption of model activities" (p. 3). The study was conducted at the University of Florida and included 52 undergraduate STEM students with LD. Mentors consisted of 34 faculty members and 57 graduate students and were also instructed in and implemented the principles of UDL in their sessions. Study experts in LD held monthly group discussion meetings with the undergraduate participants. Undergraduate participants also met individually with their graduate student mentor at least bi-weekly.

Results of the study showed an increase in the self-efficacy of the undergraduate participants. Scores from the ABCS and the IIS showed a statistically significant increase compared to baseline scores. Scores from the PGIS did not significantly change. Overall results of the study showed a positive change in success for STEM students with LD.

Conclusions

As more students with disabilities endeavor to enter STEM fields, STEM faculty need to be prepared to engage all students in their lessons (Newman et al., 2011). Universal Design for Learning is one way to make every lesson accessible to every student. By making STEM content accessible to all students, colleges and universities may see an increase in STEM enrollment by underrepresented populations (Newman et al., 2011).

Using UDL in postsecondary education is one way to decrease the barriers students with disabilities face in STEM education. Creating classrooms that are accessible to all students opens pathways for students with disabilities they may not have considered before. Universal design has been researched at the secondary level and shows marked improvement for students with disabilities (Rao et al., 2014). Continuing the research that is done at the secondary level can help students with disabilities transition more smoothly into postsecondary STEM majors. Projects that focus on helping professors and instructors create syllabi, lessons, and assessments that are accessible will lead the way for students of all abilities to be successful in STEM fields. As more students with disabilities enroll in STEM courses, instruction needs to be tailored to fit the needs of all students. Planning ahead for all abilities, which the UDL framework advocates, will help relieve stress from professors trying to adapt at the last minute for unique student abilities. Knowing lessons are already planned and take into account learner variability will also provide a level of comfort for students knowing they will be supported throughout their coursework.

The number of empirical research studies exploring the efficacy of UD for postsecondary STEM education remains too small to indicate widespread success of the model and to provide examples for interested instructors. While a few empirical research articles were found in this review, many faculty are already implementing the principles of UDL (Basham & Marino, 2013). Most research on UDL in postsecondary education has been in non-STEM majors. Many studies qualitatively examined the perspectives of students and faculty on the use of UDL in postsecondary education. However, there is limited evidence on the results of using UDL in a postsecondary setting, specifically targeting student growth. Since executive function (EF) skills are common across several diagnoses, including attention deficit hyperactivity disorder, learning disabilities, and autism spectrum disorder, we suggest EF disorders are an important focus for future research (Barkley, 2012; Denckla, 2007; Pellicano, 2012).

Additionally, researchers should be specific about the types of instruction they are investigating. Recent calls in postsecondary STEM education emphasize the need for "active learning," which often includes group work and increased need for self-regulation both during and outside of formal class time. While these strategies have shown benefit for students overall (Freeman et al., 2014), the research base does not exist to determine their effectiveness for SWD. This research is necessary because active learning could provide both advantages and disadvantages for students with EF disorders. For example, while a variety of instructional practices, such as mini-lectures, think-pair-share, demonstrations, and student-led presentations, may provide multiple means to access information (aligned with UDL), the many small, timed assignments that result may tax executive function and be difficult for students to track. Group and teamwork may allow SWD to capitalize on strengths and minimize impact of weaknesses, but groups or teams may not be well composed, may draw attention to students' weaknesses, and may tax social skills. In redesigned learning spaces, the instructor's presence throughout entire classroom and use of student work may help hold attention; however, there may be no "front" of the classroom, leading to difficulties with attention.

Given the lack of research found for UDL in postsecondary STEM, additional research is necessary to validate the effectiveness of the UDL principle in this setting. The National Science Foundation, the U.S. Department of Education, and the National Institute of Health have funding opportunities for research in postsecondary STEM education for underrepresented populations.

Limitations

Several limitations may affect the results of this review. Relevant articles may not have been indexed by databases searched or may have used different key terms. Our search focused on "STEM," and articles may emphasize a specific discipline within STEM (such as physics). Additionally, some articles used the ideals of UDL but did not classify their approach as UD and were not included. Articles not published in peer-reviewed journals were not included in this search. In a search on the National Science Foundation's website, two ongoing projects were found to increase the number of students with disabilities in STEM majors. The components used in each project were based on the three UDL principles, however either the project did not use the term UDL or it did not have research based articles that met the three criteria used in this review: STEM, postsecondary, and UDL.

Abbreviations

ABCS:

Academic Behavioral Confidence Scale

ADHD:

Attention deficit hyperactivity disorder

ANOVA:

Analysis of variance

CAST:

Center for Applied Special Technology

CS³LD:

Comprehensive Support for STEM Students with Learning Disabilities

EF:

Executive function

GPA:

Grade point average

IIS:

Institutional Integration Scale

LASSI:

Learning and Study Strategies Inventory

LD:

Learning disabilities

MPLTL:

Mastery Peer-Led Team Learning

NLTS2:

National Longitudinal Transition Study-2

PGIS:

Personal Growth Initiative Scale

PLTL:

Peer-Led Team Learning

STEM:

Science, technology, engineering, mathematics

SWD:

Students with disabilities

SWoD:

Students without disabilities

UD:

Universal Design

UDI:

Universal Design for Instruction

UDL:

Universal Design for Learning

WWC:

What Works Clearinghouse

References

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Acknowledgements

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Funding

The material in this manuscript is based upon work supported, in part, by the National Science Foundation under Grant Award Number 1612009. Any opinions, findings, and conclusions or recommendations in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

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Author information

Affiliations

1. Department of Child, Family, and Community Science, University of Central Florida, Orlando, FL, 32816, USA

Jillian Schreffler & Eleazar Vasquez III

2. Physics Department, University of Central Florida, Orlando, USA

Jacquelyn Chini & Westley James

Contributions

JS made substantial contributions to the conception, design, analysis, and interpretation of data. EV, JC, and WJ were involved in revising the article for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jillian Schreffler.

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Competing interests

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Schreffler, J., Vasquez III, E., Chini, J. et al. Universal Design for Learning in postsecondary STEM education for students with disabilities: a systematic literature review. IJ STEM Ed 6, 8 (2019). https://doi.org/10.1186/s40594-019-0161-8
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DOI: https://doi.org/10.1186/s40594-019-0161-8

Keywords

STEM

UDL

UDI

Universal Design

Postsecondary

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Universal Design for Learning in postsecondary STEM education for students with disabilities: a systematic literature review - International Journal of STEM Education

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Universal Design for Learning is not widely used in postsecondary STEM education. The purpose of this literature review is to synthesize the empirical literature using Universal Design for Learning in postsecondary STEM education for all learners. The criteria for this review are (a) empirical literature in (b) peer reviewed journals (c) published after 2006.

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STEM and People with Disabilities: DO-IT Video

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Opportunities in science, technology, engineering, and mathematics are plentiful. Ensuring that students with disabilities have equal access to STEM academic programs and careers is critical. Learn how the accessibility of STEM activities can be increased and how students with disabilities can prepare for these fields of study and employment.

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Assistive Technology Internet Modules FREE

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Assistive Technology Internet Modules FREE

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Center on Technology and Disability (CTD)

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A center that provides assistive technology, assistive technology devices, assistive technology tools, assistive technology apps, assistive technology for cerebral palsy, assistive technology evaluation, assistive technology software, assistive technology provider, ipad as assistive technology, speech and language assistive technology.

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Link to make a copy: https://docs.google.com/presentation/d/1CKWFByvuLqifc0dK3BY2aWDFKVPyOfshDMW4nc57ZJI/copy#slide=id.p

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CAST's UDL Curriculum Self-Check makes use of both Javascript and cookies for various features.

In order to login and use the UDL Curriculum Self-Check please enable both Javascript and cookies within your Internet browser.

Welcome to the CAST Universal Design for Learning (UDL) Curriculum Self-Check

Use this site to help you apply UDL principles in your teaching to reach and engage all of your students. The goal of UDL is to enable all individuals to gain knowledge, skills and enthusiasm for learning. Learn about UDL, Check Your Curriculum, or Explore Resources for ideas on how to build options and flexibility into each element of your curriculum.

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CAST's UDL Curriculum Self-Check makes use of both Javascript and cookies for various features. In order to login and use the UDL Curriculum Self-Check please enable both Javascript and cookies within your Internet browser. Welcome to the CAST Universal Design for Learning (UDL) Curriculum Self-Check Use this site to help you apply UDL principles in your teaching to reach and engage all of your students.

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Introduction

RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America, is the premier professional organization dedicated to promoting the health and well-being of people with disabilities through increasing access to technology solutions. RESNA advances the field by offering certification, continuing education, and professional development; developing assistive technology standards; promoting research and public policy; and sponsoring forums for the exchange of information and ideas to meet the needs of our multidisciplinary constituency. RESNA is a 501 (c) 3 not-for-profit membership association

The organization's legal name is RESNA.

RESNA's goal is "To maximize the health and well being of people with disabilities through technology."

The purpose of RESNA is to contribute to the public welfare through scientific, literary, professional and educational activities by supporting the development,dissemination, and utilization of knowledge and practice of rehabilitation and assistive technology in order to achieve the highest quality of life for all citizens.

What RESNA Offers

RESNA has the following web pages relevant to its mission.:

In addition, RESNA manages the following federal grant project. Click the link to learn more:

RESNA also works to keep members and assistive technology professionals current on technology trends and encourages collaboration and information sharing through a variety of communication tools.

RESNA participates in government affairs and public policy development at the international, federal, state and local level. Please follow the Government Relations link to learn more.

Bylaws

The RESNA Bylaws set forth the basic structure and abilities of the RESNA Board and the organizational bodies which it oversees, and establishes how the Board conducts business.

Strategic Plan

RESNA's five-year strategic plan reflects our vision to be the leading source of knowledge and leadership in Rehabilitation Engineering (RE) and Assistive Technology (AT) in North America and around the world. View the RESNA 2019-2023 Strategic Plan.

History

RESNA was founded in August 1979 by a group of engineers and scholars attending the Inter-Agency Conference on Rehabilitation Engineering. Click here to learn more about RESNA's history...

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RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America, is the premier professional organization dedicated to promoting the health and well-being of people with disabilities through increasing access to technology solutions.

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What is UDL? Universal Design for Learning Explained (3 minutes)

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Assistive Technology Video Series: Switches