Assistive Technology Access and Usage Barriers Among African Americans With Disabilities: A Review of the Literature and Policy

Abstract

The purpose of this article was to provide a comprehensive overview of the available peer-reviewed and gray literature on assistive technology (AT) access and usage barriers among African Americans with disabilities. Authors completed a historical review (Onwuegbuzie & Frels, 2016) of the extant literature on AT and disability public policy mandates by framing the context on AT access and usage disparities among African Americans with disabilities and discussing AT impacts on employment for African Americans. The authors also presented recommendations that might be considered by the field for increasing AT access and usage among African Americans with disabilities. It is clear that AT and associated assistive products are important commodities to the lives of individuals with disabilities in the United States; however, there are historical inequities between African Americans and Whites. As a result of these findings, the authors implore rehabilitation counselors in education and practice to further examine ways to alleviate the AT access and usage gaps for African Americans with disabilities within public policy, vocational rehabilitation service delivery, and institutional infrastructure systems.

For African Americans, inequities in assistive technology (AT) access and usage, and technological innovations, can further disenfranchise this already marginalized group (Subramony, 2007, 2011, 2014). According to Rogers (2016), the technology gap, also known as the “digital divide” is an important issue for social justice in the 21st century. The term “digital divide” coined during the Clinton administration (1993–2001), describes inequitable access to computers and the Internet experienced by people of color. Almost two decades ago, DiMaggio and Hargittai (2001) framed digital inequality along the following five dimensions; technical apparatus or equipment, digital skill, social support, purposes for technology use, and the autonomy of use. Nearly 20 years later, their description has evolved to include inequalities in technological skills and application (Rogers, 2016). For African Americans with disabilities, this gap extends further and includes discrepancies in control of technology production tools and the appropriate context to use those tools (Rogers, 2016; Schradie, 2011; Subramony 2007, 2014).

As African Americans with disabilities continue to strive for equitable access to technology, in general, and AT, in particular, the digital divide provides a historical framework for identifying present disparities. Kvasny (2006), states that the digital inequality reflects not only disparities in the structure of access to and use of information and communication technologies (ICT); it also reflects the ways in which long standing social inequalities shape beliefs and expectations about ICT and its impacts on life chances. Hence, the digital divide grants people from historically privileged groups and economic backgrounds a higher level of technological empowerment to use their Internet access to advance their education, participation in the job market, social standings, and other beneficial life choices (Mavrou, Meletiou-Mavrotheris, Kärki, Sallinen, & Hoogerwerf, 2017).

Universal AT access is an essential part of human life that provides critical links to many opportunities, including but not limited to employment, community participation, and education (Borg et al., 2012). AT accessibility is about ensuring access to technological and innovation information by making specific accommodations for particular disabilities, or more specifically to the types of innovations that individuals with disabilities would presumably use. Some research (i.e., Borg et al., 2012; Carey, DelSordo, & Goldman, 2004; Clay & Alston, 2016a; Kaye, Yeager, & Reed, 2008) has shown that for assistive products to be selected and utilized optimally, the technology must be “affordable, reliable, maintainable, and of sufficient design quality so that the assistive product will enable the intended assistance” (Stumbo, Martin, & Hedrick, 2009, p. 99).

Although some assistive products are low-tech devices (e.g., canes, eyeglasses, or manual wheelchairs), the authors argue that African Americans with disabilities may be at greater risk for exclusion from programs and services that provide access to high-tech AT devices, such as vehicle modifications and residential remodeling, as a result of the digital divide. As multiple minorities, generations of disparities have left many African Americans with disabilities in the fringes of a technologically advanced society. Considering private industries and government agencies increasingly rely on computer-based marketing and management systems, African Americans with disabilities with limited access to the Internet and social media may be less likely to hear about available AT services, let alone apply for the funding necessary to secure such high-tech assistive products. To address these disparities, organizations, scholars, and researchers have all shown interest in developing innovative approaches to foster access to lifelong learning and key AT competencies. Such strategies include systems to certify training pathways in AT, and projects aimed at equipping the community with informal learning and exchange tools (Mavrou et al., 2017). Nevertheless, the scientific literature suggests that although individuals with disabilities of all ages have personal experience with AT, they tend to lack sufficient skills and knowledge to effectively participate in the digital society and to contribute to the reduction of the socioeconomic digital divide (Boot et al., 2018; Goedhart et al., 2019; Newman et al., 2017; & ViPi Project, 2013). Hence, the digital divide can be bridged with further research and collaborative efforts in-service delivery, education, and public policy. The state–federal vocational rehabilitation (VR) system, discussed hereafter, is one avenue to address such AT disparities and move toward digital inclusion.

As an initial step toward the above-stated goal, the authors conducted a historical literature review by completing the following process. First, the research team identified relevant legislative initiatives that have directly or indirectly addressed AT access and usage disparities for African Americans with disabilities. Second, the research team conducted a search of online library databases (i.e., Academic Search Premier, ERIC, and EBSCOHost), to locate peer-reviewed journal articles, books, book chapters, government reports, and other publications related to the topic of interest. Lastly, the team traced the evolution of the issue, as it emerged throughout the literature (Onwuegbuzie & Frels, 2016), and sorted the legislation and available literature chronologically, as presented below.

PUBLIC POLICY CONTEXT

Over the past four decades, various U.S. public policy mandates (see Table 1) have helped to frame the rehabilitation disparity context relative to African Americans with disabilities (Lewis, Seelman, Cooper, & Schein, 2012). For example, the U.S. Congress amended the Rehabilitation Act of 1973 (P.L. 93-112) passing into law Section 21 of the 1992 Rehabilitation Act Amendments. Section 21 empowers African Americans with disabilities in their pursuit of competitive integrated, employment (Moore & Alston, 2017). This legislative priority, along with available extant literature highlight the need to promote equal access to AT among African Americans with disabilities seeking employment.

TABLE 1.

AT Public Policy Laws

Statue	Title	Purpose
Pub. L. 100-407	Technology-Related Assistance for Individuals with Disabilities Act of 1988 (Tech Act)	Financial help to states to: conduct assessments, identify resources, provide services, conduct public awareness AT campaigns.
		Endorsed evaluation, procurement, leasing, design, fabrication, training, and technical assistance to individuals.
		Children and adults with disabilities eligible for AT services
Pub. L. 103-218	Technology-Related Assistance for Individuals with Disabilities Act Amendments of 1994	Amended The Tech Act National classification system for AT services and devices Mandated six activities for states:
		1 Develop and monitor policies to improve AT access
		2 Develop and implement strategies to address funding barriers
		3 Coordinate state agency AT activities to increase access
		4 Empower individuals with disabilities to advocate for improved access, choice, and control in AT selection
		5 Provide outreach to underrepresented and rural populations
		6 Develop and implement strategies to improve AT for children
Pub. L. 105-394	AT Act	Provided resources to states for three new programs:
		1 AT demonstration and information centers and equipment loan program
		2 Protection and advocacy services to AT recipients
		3 Federal and state-based low-interest loans to help persons with disabilities purchase AT
Pub. L. 108-364	AT Act of 2004	Amended The AT Act
		Moving more AT directly to persons with disabilities
		States were required to earmark a minimum of 60% of their federal AT dollars for alternative financing and loan programs for devices
		Clearly defined AT and made resources available for national AT activities
		Funds for demonstration centers and recycling programs for devices were rendered discretionary
Pub. L. 111-260	Twenty-First Century Communications and Video Accessibility Act of 2010	Worked to ensure full participation by individuals with disabilities in new Internet-based and mobile services technologies
		Goal: to assist people with vision and hearing impairments to have improved access to television, video, Internet, and smartphone technology
		Rendered emergency information more accessible to individuals who are deaf and blind

Limited access and usage of available technologies impede employment among African Americans with disabilities compared to their White counterparts (Loggins, Alston, & Lewis, 2014; Kaye et al., 2008). Access to appropriate AT devices in employment settings can mean the difference between being locked in poverty and having the opportunity to work and earn a living (World Health Organization [WHO], 2017). Unmet AT needs can lead to negative outcomes such as lack of integration into society, potential social or physical isolation, economic disadvantage, or even failure to meet basic needs (Kaye et al., 2008). As a result, many individuals with disabilities may experience disadvantages in their ability to participate in daily tasks, including but not limited to employment. As technology plays an increasingly critical role in modern employment settings, rehabilitation service providers and employers must capitalize on daily AT and products to in order facilitate increased workplace productivity and quality of life. There is a marked demand for creative innovations and methods that can assist individuals with disabilities in the world of work now more than ever (Foley & Ferri, 2012), especially among African Americans with disabilities.

HISTORICAL DISPARITIES IN AT ACCESS AND USAGE

For more than a decade, researchers, disability advocates, and rehabilitation professionals have drawn attention to pervasive disparities in AT access and usage among African Americans with disabilities compared to their White counterparts in the United States (Alston, Lewis, & Loggins, 2014; Carey et al., 2004; Clay & Alston, 2016a, 2016b; Huang et al., 2016; Kaye et al., 2008; Loggins et al., 2014).

AT Financing

A seminal study on this topic (Carey et al., 2004) explored the relationship between race/ethnicity and AT access, more specifically AT financing systems within a disability context. This study surveyed 654 applicants drawn from 10 different states (n = 498 White respondents; n = 156 African American respondents). The findings indicated that African Americans with disabilities were underrepresented in alternative financing programs (low-interest loan funds, below market rate loans, revolving loan funds, interest buy-down programs). Additionally, thePdf_Folio:119 study revealed that African Americans were less likely than Whites to be referred to AT through traditional sources (i.e., professionals, agencies, or businesses) and more likely to hear of AT financing opportunities through other sources (e.g., Internet searches, advertisements, etc.).

Although, Carey et al. (2004) found that African American applicants with disabilities were more likely to be employed, looking for funding opportunities, and possessed more experience with the funding process, they were still less likely to be approved for funding from traditional sources (i.e., banks, VR, or other agencies) compared to their White counterparts. The results also revealed that compared to Whites, African Americans surveyed were less likely to have alternative financing programs applications approved, regardless of their income levels or the requested loan amount. Alternative financing programs allow individuals with disabilities to access high quality AT that might otherwise be unaffordable. Access to such funding can impede an individual’s ability to be successful in employment, and the sparse available research (i.e., Carey et al., 2004; Kemp & Parette, 2000; Skylar, 2008) has shown race to be a significant predictor of such denials.

AT Access and Usage

In 2008 Kaye and researchers identified disparities in AT usage between African Americans and Whites with disabilities. This California based inquiry used a Participatory Action Research approach involving a sample of 1,714 respondents ages 18 and above with one or more disabilities. Although exact numbers were not reported, the racial/ethnic composition of the sample was 12.5% African American, 13.9% other race, 17.0% Latino, and 56.6% White. The study revealed that African Americans with disabilities had significantly lower levels of AT usage, and were less likely to use high-tech assistive products, compared to Whites with disabilities. These findings are not surprising given that African Americans have a documented history of denied access to AT funding sources, such as alternative financing programs (Carey et al., 2004; Kemp & Parette, 2000; Skylar, 2008).

Recent studies have reported mixed findings when comparing AT usage rates between African Americans and Whites with disabilities. Using a nationwide database (i.e., 2007 Behavioral Risk Factor Surveillance System [BRFSS]) of 38,499, to compare African Americans (n = 4,509, 11.7%) and Whites (n = 33,990, 88.3%) with physical disabilities, Loggins et al. (2014) reported several differences in usage rates (Loggins et al., 2014). They found that African Americans were 29% more likely than Whites to use AT. However, there were several important between group differences. Compared to Whites, African American respondents were more likely to have lower incomes, less education, higher unemployment rates, no health coverage, and were more likely to report medical costs as an issue. In an analysis of AT usage rates among veterans with severe disabilities (N = 1,086), Alston et al. (2014) reported results between African American (n = 159) and White respondents (n = 927) that refuted the results from the Loggins et al. 2014 study. According to their findings, African American veterans with severe disabilities were 60% less likely to use AT than White veterans.

Three studies published 2 years later (i.e., Huang et al., 2016; Loggins Clay, & Alston, 2016a, 2016b) added to the science on race/ethnicity and AT usage. Huang and colleagues conducted a secondary analysis of RSA-911 data (FY 2009) using a sample of 32,088 successfully closed VR cases with African Americans (n = 7,397 or 23.1%) and Whites (n = 20,704 or 64.5%). The results indicated that only 10.4% of consumers received AT, and of those individuals, African Americans were 24% less likely than Whites to receive assistive innovations (Huang et al., 2016). In contrast, Clay and Alston (2016a) reported that African Americans with physical disabilities were more likely to use AT based on their analysis of 2013 Medical Expenditure Panel Survey (MEPS) data.

Finally, Clay and Alston (2016b) analyzed BRFSS data collected in 2012 and reported that African American veterans overall were 1.3 times more likely to use AT than White veterans. Interestingly, when gender was added as a variable, White male veterans used AT more often than African American male veterans, while the inverse was true for White female veterans compared to African American female veterans. Overall, study results revealed disparities similar to previous findings; African American veterans who used AT had lower socioeconomic status, lower income levels, poorer educational attainments, were more often unemployed, uninsured, less likely to be married, and reported fair or worse general health and more issues with the costs of medical care compared to White veterans (Clay & Alston, 2016b).

Considering the documented disparities in AT usage, rehabilitation professionals are in a unique position to deliver culturally competent services to continue to counter these historical inequities. Almost two decades ago, Middleton et al. (2000) issued a “Call to Action” declaring a need to endorse multicultural rehabilitation counseling competencies, foreshadowing the importance of delivering culturally competent AT services. However, now might be the time to apply culturally competent standards to the expansion of AT awareness, access, and usage for individuals with disabilities from traditionally underserved racial and ethnic populations. Historically Black Colleges and Universities (HBCUs) are a great resource to the African American community to begin delivering such standards.

ICT/Digital Technology Barriers Related to AT

The National Telecommunications and Information Administration (NTIA) national survey reported 78% of Americans ages 3 and older used the Internet as of November 2017 (Redi, 2018). But even as a growing share of these Americans report going online or owning a smartphone, the digital divide between those who have a disability and those who don’t remains large. Individuals with disabilities are about three times as likely as those without a disability to say they never go online (23% vs. 8%), according to a Pew Research Center survey conducted in the fall of 2016. Digital technology is an increasingly important resource for participating in today’s world. Considerable research has documented how digital inequality plays out across society (Dobransky & Hargittai, 2016). The absence of basic access to or lack of skills using these resources can have critical effects on one’s relationships, work, and overall quality of life. Besides technical access to the Internet effects of digital inequalities include differences in autonomy of use, availability of support, skills, and the purpose of Internet use (Hargittai & Hsieh, 2013). Researchers have found that individuals with disabilities are less likely to use the Internet and are less likely to engage in a range of activities even when in use (Dobransky & Hargittai, 2016; Anderson & Perrin, 2017; Robinson et al., 2015).

One-in-four adults with a disability reported having high-speed Internet at home, a smartphone, a desktop or laptop computer, and a tablet, compared with 42% of those who report not having a disability (Pew Research Center, 2017). Additionally, individuals from lower socioeconomic statuses as well as those from diverse racial and ethnic minority groups have been found to use the Internet less likely than their counterparts (Robinson et al., 2015). Thus, having less access to the Internet may further compound the socioeconomic and racial/ethnic minority inequalities that individuals with disabilities already face. To address the digital inequalities there are several mandated and recommended guidelines for making computers and the Internet accessible. However, much of the focus tends to be on AT after the fact, add on solutions such as screen readers, speech-to-text programs and other accessibility addition workstations (Piper, Weibel, & Hollan, 2014). Although Section 508 addresses Federal Government Websites, private businesses are not covered by this regulation (ADA, 2008). The Americans with Disabilities Act (ADA) covers accessibility of “public accommodations,” yet entities that operate solely online have not clearly been ruled as covered by this mandate (Dobransky & Hargittai, 2016). Ultimately, AT users continue to find themselves in a limited range of options available and lack training, support, and assistance needed to make use of them (Harris, 2014). As we look at the growth of individuals with disabilities and the aging trend, including aging workforce, targeted attention needs to be devoted to this area as a demand for increased accessible technologies (Lewis et al., 2012).

AT AND EMPLOYMENT

AT Impacts on Employment

Individuals with disabilities in the workforce face pay and benefit disparities, less job security, lower participation in organizational decision-making, and receive less formal and informal training (Erickson, von Schrader, Bruyère, VanLooy, & Matteson, 2014; Schur, Kruse, Blasi, & Blanck, 2009). These obstacles are compounded for African Americans with disabilities (Carey et al., 2004). Research has consistently shown that African Americans with disabilities are significantly less likely to secure employment when compared to their White counterparts (Moore & Wang, 2016; Sevak, Houtenville, Brucker, & O’Neill, 2015). For example, Sevak et al. (2015) found that regression-adjusted gap in employment rates between people with and without disabilities across the United States was highest for African Americans at 37.5% points, based on results from an analysis of data collected by the U.S. Census from 2009 to 2011. Analyzing RSA-911 data (N = 11,603), Moore and Wang (2016) reported that African American female veterans experienced statistically significantly lower return-to-work rates than their White female counterparts. Overall, the study results documented that African Americans experienced the worst return-to-work probabilities when compared to all other racial groups.

Additional research has investigated AT impacts on employment outcomes within racial/ethnic context. Sprong, Dallas, Paul, and Xia, (2019) examined FY RSA-911 case record data and found White consumers who received AT/rehabilitation technology (RT) services had a significantly higher successful closure rate than other races/ethnicities. Likewise, Cimera, Rumrill, Chan, Kaya, and Bezyak (2015) analyzed FY RSA-911 data to evaluate the impact of demographic variables and VR services on, employment outcomes among, transition ageyouth (i.e., 16–25 years old) with visual impairments and blindness. Young adults who were male, Latino, between the ages of 23–25, did not receive Social Security Disability benefits, and diagnosed with less severe visual impairments were more likely to secure employment. Receiving reader and AT services also predicted successful employment outcomes (Cimera et al., 2015). The contemporary cited research studies discussed exemplify how vital assistive products are to individuals with disabilities in sustaining competitive integrated employment and basic activities of daily living (Morash-Macneil, Johnson, & Ryan, 2017; Shin, 2016; Wang et al., 2018).

However, in addressing existing barriers among African Americans with disabilities they have done little to increase the field’s understanding about AT services and rehabilitation outcomes among African Americans with disabilities. The variation in employment outcomes across racial and ethnic groups presents an opportunity to learn more about AT factors that can reduce the employment gap Sand lead to the development of new policy initiatives, programs, and service interventions (Sevak et al., 2015). For instance, in one of the few available inquiries, Clay and Alston (2016b) analyzed FY 2013 MEPS data and reported that individuals with physical impairments only and individuals with physical impairments who used AT were most often White, female, married, had higher educational levels, had healthcare coverage, and were not employed (Clay & Alston, 2016b). For African Americans with physical conditions in the study who used AT there was a higher percentage of marriage, health coverage, and unemployment (Clay & Alston, 2016b). African Americans with physical conditions who used AT comprised a higher percentage of marriage, health coverage, and unemployment (Clay & Alston, 2016b). Based on these studies reviewed above and the limited literature available, more empirical research is needed to explore the impact of AT in the workplace, and the potential impact on employment outcomes for African Americans with disabilities.

African Americans With Disabilities Striving to Work

According to recent U.S. Bureau of Labor Statistics (BLS) report, the unemployment rate for individuals with disabilities was 9.2% in 2017, more than twice that of those without a disability (4.2%; BLS, 2017). An examination of unemployment rates by race and ethnicity reveals that critical disparities are especially salient. African Americans do not only, report higher rates of disabilities when compared to the majority population (1 in 4 compared to 1 in 5 for non-Hispanic Whites; CDC, 2019), they also experience proportionately higher unemployment rates as well (13.8%–8.5%, respectively). These statistics are unfortunate and portray a vast number of unemployed African Americans with disabilities that do not have access to AT that could enable them to work because African Americans experience the highest jobless rates among individuals with disabilities in the United States (BLS, 2017). Additional service, policy, research, and AT research and development (AT-R&D) efforts are needed to dismantle barriers and improve employment outcomes for African Americans with disabilities.

Although AT is an important commodity to the lives of these individuals, there are historical access and usage disparities across racial and ethnic groups, especially between African Americans and Whites. For more than a decade, researchers, disability advocates, and rehabilitation professionals (i.e., Alston et al., 2014; Carey et al., 2004; Clay & Alston, 2016a, 2016b; Huang et al., 2016; Kaye et al., 2008; Loggins, Alston, & Lewis, 2014) have drawn attention to such AT access and usage inequalities in the United States of particular importance, Section 21 of the Rehabilitation Act Amendments of 1998 (Public Law 93-112) was mandated by the U.S. Congress to address the underrepresentation of African Americans in public VR services, and disparate, poorer rehabilitation outcomes for members of this target population (Moore, Lewis, & Rosen-Reynoso, 2017).

State–Federal VR System

The state–federal VR system is the largest provider of employment and independent living services for individuals with disabilities in the United States (Martin, West-Evans, & Connelly, 2010). The Smith-Fess Act of 1920 (P.L. 66-236) was the key piece of legislation that expanded rehabilitation services beyond military service members to include civilians with physical disabilities (Chan, Bishop, Chronister, Lee, & Chiu, 2017). The Barden-LaFollete Act of 1943 (P.L. 78-113) was drafted to include VR services for individuals with mental disabilities (Chan et al., 2017). The Rehabilitation Act of 1973 and subsequent amendments mandated services for individuals with the most severe disabilities and included independent living services along with employment goals (Rubin, Roessler, & Rumrill, 2016). State–federal VR services are provided to individuals with disabilities who meet the federal criteria for eligibility (i.e., have a mental or physical impairment resulting in significant employment barriers and can benefit from VR services to meet an employment goal; Condon, Gandolfo, Brugnaro, Thomas, & Donnelly, 2004). State–federal VR programs specifically offer employment-related services charged with improving employment outcomes for individuals with disabilities. This population has experienced persistent employment challenges when compared to individuals without disabilities, as several studies delineate below.

AT service delivery within the state–federal VR system has been in development over the past four decades (Noll, Owens, Smith, & Schwanke, 2006). During this time, the National Council on Disability (1993) noted that public policies and programs for Americans with disabilities advantage the majority population and have not adequately benefited minorities with disabilities, specifically African Americans (Carey et al., 2004). AT is described as RT by the Rehabilitation Services Administration (RSA), and RT is a service that can be provided to eligible consumers by the state–federal program for VR. In public VR program there are three different types of RT services available. These include, rehabilitation engineering services, AT devices, and AT services. Limited research is known about AT services and outcomes among African Americans with disabilities.

Current AT theories and practices emanate from Western philosophies and ideologies that favor autonomy, independence, and self-determinism (Ripat & Woodgate, 2011). To address these inherent biases and provide appropriate AT service delivery requires ideal AT classifications derived from a comparison and analysis of several pieces of legislation. They are the ADA of 2008 definitions for disability and major life activities, the American Technology Act (ATA) of 2004 definitions for AT, and the International Classification Functioning (ICF), Disability and Health conceptual framework.

The ICF approved by the WHO in 2001, provides a globally agreed-on “unified and standard language and framework for the description of health and health related states” (WHO, 2001, p. 3). The ICF recognizes and presents health conditions, environmental and personal factors, body functions and structures, and domains of activities and participation. AT is illustrated to be an environmental factor used to overcome health state impairments, and health-related limitations and restrictions. The ICF, thus presents disability not as an impairment of the individual or shortcomings of the environment but instead as arising from the interface of the individual and the environment. The ICF is an ideal framework to consider the relationship between AT, health, and health-related domains in state–federal VR systems.

Moreover, increased access and usage of AT aligns with the social model of disability by focusing on dismantling environmental obstacles rather than focusing on characteristics within the individuals, as the medical model purports (Campbell & Oliver, 2013; Scherer & Glueckhauf, 2005). Many federal and state policies have been driven by the medical model, which focuses on the physical, sensory, or cognitive status of a person considered disabled (Braddock, Rizzolo, Thompson, & Bell, 2004). This model also drives the funding for Medicaid, Medicare, and private insurance providers (Wallace, 2011). This disability model represents a Western view that characterizes disability as an abnormality in which cure is the answer and assumes a part of the person is broken and can be fixed (Rees, 2017). The medical model’s diagnosis and treatment of individuals with disabilities focuses on physical and biological aspects of a condition without referring to cultural or holistic understandings of development (Rees, 2017). This reinforces service providers’ (e.g., physicians and other qualified medical healthcare professionals) power to make key decisions about health issue, as service recipients are viewed as patients. Lastly, this model operates with medical professionals providing rationale that a disability deficit is present and that a medical necessity exists justifying the AT product or service (Wallace, 2011).

Many AT service providers, investors, research scientists, and engineers belong to a culture of their own, the majority consisting of university-educated, middle class individuals who do not consider themselves as members of the disability community. Individually and collectively, these groups hold the power and the ability to perpetuate the dominant culture on disability in general, and AT, more specifically (Ripat & Woodgate, 2011). Race is more than just a dummy variable that can be added to linear regression models (Rubin & White-Means, 2001); rather, VR service delivery providers must carefully consider the intersectionality among race, disability, and AT access and usage for African American consumers with disabilities as the expectation, not the exception (Ripat & Woodgate, 2011).

IMPLICATIONS AND RECOMMENDATIONS

The intent of this article was to examine the available literature on AT access and usage barriers for African Americans with disabilities. The results illuminate pervasive access and usage disparities experienced by African Americans with disabilities; exacerbated in part by outdated AT public policy, the digital divide, and uninformed VR service delivery. We present the following recommendations for alleviating these inequities.

Outdated Public Policy

Current AT public policy needs reexamination that takes into account technological advances in a holistic manner as well as the perspectives of multiple disability stakeholders including African Americans with disabilities. In general, the need for an effective AT public policy specific to culturally diverse individuals’ access and usage is evident (Layton, 2015). Many existing regulations and policies have been established and decided without consideration of AT access and use among members of this target population. We recommend that AT policy strategists and researchers’ interface to carry out feasibility studies documenting the advantages (i.e., cost benefit analysis) of guidelines targeting African Americans with disabilities; transferring the burden of traversing insurmountable challenges to access these products from them to society itself. Incorporating the above policy analysis might translate new strategies into the hands of the rehabilitation professionals about how AT can be made more readily accessible by reducing waste and inefficiency.

Examples of equitable access in AT public policy can be represented in a shift change from individual systematic level costs to “economics of inclusiveness” where all-inclusive environment expenditures are calculated across all community members who could benefit (Layton, 2015). Developing committees to monitor and promote implementation can aid policy makers in legislation procuring accessible products and services facilitating increased employment of African Americans with disabilities in the government, in addition to setting a standard of practice for the larger labor markets. Moreover, comprehensive policy framework regulations inclusive of accessibility in licensing, designs, conditions, authorizations, and guidelines for codes of conducts target challenges in existing legislation and policy in need of revision and innovation.

There is a visible disconnect between African Americans with disabilities and technology. Societal, legislative, personal, and infrastructural factors might contribute to bridging this digital divide. Furthermore, it is imperative that individuals who seek AT should know their rights under various AT public policies in addition to being equipped to defend funding requests decisions or facilitate appeals necessary. Access to such information and alternative AT funding sources is a critical step to increasing access and usage among African Americans with disabilities (e.g., partnerships with minority-owned banks, obtaining lower interest rate loans, and utilizing AT rental systems). In the rapid developments of digital technologies cost and availability of accessible technology has served as a disruptive force in AT, widening the gap for most in making things possible and impossible for individuals with disabilities.

Bridging the Disability and Technology

Technology alone is not sufficient to erase the digital divide and ICT/digital technology barriers. Finances play a significant role in deleting the digital divide in education, disability, employment, and social benefits. Affordability is a major barrier to technology access. First, this can be overcome through continued proliferation of high-functional and low-cost mobile devices, providing public access through schools, libraries, and other community gathering points to achieve universal service access extending through all communities’ is vital (Harniss, Samant Raja, & Matter, 2015; Parette, Huer, & Hourcade, 2003).

Second, digital literacy skills must be learned and enhanced. By involving consumers in conversations on design, and how best they can be reached is beneficial (Parette et al., 2003). Identifying trusted community leaders or service providers with the digital marginalized user’s needs and not their own commercial or political interest will also have far more success in ensuring they have the resources and the digital literacy skills needed to overcome technological barriers. Lastly, providing ongoing support is important through safe low- or no-cost environments to train individuals to be digital literate, and reach future tech users.

VR Service Delivery

AT is becoming increasingly important to the field of VR counseling, as it is often key to independence and employment for people with disabilities. The following recommendations are presented for VR service delivery among African Americans (for further implementation see Table 2):

TABLE 2.

As a Part of the Overall VR Service Delivery Process Regarding AT Access and Usage Among African Americans With Disabilities the Following Recommendations Are Suggested

VR Personnel Area	AT Service Delivery Focus
Knowledge	Awareness of basic AT, inclusive of public policies, services and types of devices
	Knowledge of where to go for additional information and assistance (e.g., relationships with technology specialist)
	Knowledge of available opportunities to integrate AT into clients’ life (e.g., training or workshops)
	Regularly attend AT webinars, workshops, and/or conferences
Communication and Collaboration	Utilize culturally sensitive communication (verbal and nonverbal) Be self-aware of one’s own personal biases and behaviors that might serve as a barrier
	Understand the impact of culture on the nature of the AT application and VR service delivery process
	Participate with an interdisciplinary team (e.g., rehabilitation counselor, physiatrist, occupational or physical therapists, speech and language therapists) inclusive of the client that will allow for a combination of perspectives represented around the identification of possible AT solutions
	Select AT options based on clients’ preferences
Assessment and Planning	Provide appropriate and current assessments throughout the AT application and VR service delivery process. For example, utilize the social model of disability, AT Guidelines developed by RESNA, MPT models
	Develop and design an AT intervention plan that effectively meets clients’ needs
Implementation	Implement AT intervention plan
	Provide AT education and training for clients’, family, and caregivers on how AT operates daily in various environments (e.g., work, home, and transportation)
	Provide AT resources and support (e.g., community, clubs, associations, activities at a state and national level)
Follow-up	Once the AT device or service is implemented for clients’, offer ongoing support and evaluation in the daily life context of use Check-in with clients’ overall satisfaction with AT device or service
	Prevent AT abandonment by allowing for a trial period for AT device prior to purchase and conducting periodic follow-ups (i.e., change in AT device technology or change in user needs)

• Ensure adequate maintenance of AT service needs for consumers offered within VR agencies by regularly examining current policies and practices that can be enhanced or mainstreamed (e.g., incorporate from the very beginning AT in all protocols).

• Implement AT assessments regularly with all VR consumers regardless of disability type, previous history with AT, and past experiences with VR services.

• Place more emphasis on assessing RT services for consumers (e.g., prepare finance options, provide examples of accessible AT solutions, and schedule AT training/support).

• VR counselors need to familiarize consumers who are less likely educated and/or low income how AT services could benefit them.

• State agency programs should employ rehabilitation engineering professionals (REP) to provide AT services to their consumers to reach employment goals. The REP works with the transdisciplinary team to provide AT assessments and interventions.

The Role of Rehabilitation Counselor Education Programs

As technology is continuously integrated into daily living and working environments, rehabilitation counselor education programs continue to play a vital role in nurturing AT knowledge and skills among preservice students (Connor, Kuo, & Leahy, 2018). The rehabilitation counseling profession is the only counseling specialty with AT standards of practice. The Council for Accreditation of Counseling and Related Education Programs (CACREP) 2016 Standards designate AT assessment and service delivery as expectations unique to the rehabilitation counseling specialty. AT is listed in the CACREP clinical rehabilitation counseling standards stipulate that programs must address “assistive technology to reduce or eliminate barriers and functional limitations” as a key contextual dimension (p. 26). There are several recommendations for accomplishing this objective.

First, rehabilitation counselor education programs should consider modifying current curricula to include short courses, webinars, and continuing education workshops that train preservice and in-service rehabilitation professionals to facilitate effective AT service delivery and enhance their capacity to assist clients in AT decision-making (Huang et al., 2016). Second, there may be a need for more of these individuals to learn more about AT-related legislation, policy, and available funding programs. Third, additional training across a variety of AT devices used in different settings (i.e., employment, activities of daily living, and recreation) may be warranted (Connor et al., 2018). No specific profession is taking a leadership role in AT (Connor et al., 2018). Therefore, rehabilitation counselor education programs can assume a key role in filling this gap by shaping the AT skill sets of those who serve African Americans with disabilities. These recommendations could advance AT service models and interventions in rehabilitation. Over time this function might become a part of all other professional specialties, in both the delivery and assessment of AT (Connor et al., 2018).

Conclusion

The comprehensive literature review examined AT access and usage among African Americans with disabilities and provided a brief overview of AT and disability public policy mandates. Moreover, addressing the historical context of AT access and usage disparities (i.e., the digital divide), and the potential impacts on employment. The existing AT barriers and gaps among African Americans with disabilities discussed above calls for bridging the digital divide. Public policy and VR service delivery are important to driving AT accessibility among African Americans with disabilities for integrated employment success. Recommendations of findings throughout the literature provide insights for eliminating AT barriers for African Americans with disabilities by, bridging the digital divide through public policy reform, digital literacy awareness, and enhanced capacity building within VR AT service delivery.