Assistive technology services for adults with disabilities in state-federal vocational rehabilitation programs

Abstract

Purpose:

Prior research indicates that the provision of assistive technology (AT) services positively predicts successful employment outcomes in vocational rehabilitation (VR) programs. While AT services can be promising, they are underutilized overall, and there are apparent disparities in AT service utilization. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs. Recognizing potential disparities is the first step in improving equity in access to beneficial services.

Materials and methods:

This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration’s Case Service Report from fiscal years 2017–2019. The sample included 788,173 cases that reported having a disability, were aged ≥18 years old, was deemed eligible for VR services, and had a complete set of data.

Results:

Less than 9% of VR clients received AT services. We ran a multiple logistic regression analysis to examine the independent effects of various sociodemographic variables on the likelihood of receiving AT services through VR programs. The following client characteristics were associated with a lower likelihood of receiving AT services: men, unemployed, minority, low income, significant disability, non-enrolled in post-secondary education, mental or cognitive disability, less education, and younger age (all p < .001).

Conclusion:

The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities. Future research and implications are provided.

Introduction

The Rehabilitation Act of 1973 authorized state-federal Vocational Rehabilitation (VR) programs to assist individuals with disabilities in independence, community integration, and gaining or maintaining employment. According to the Rehabilitation Act, disability is a natural part of the human experience and has no bearing on an individual’s right to pursue jobs or to be fully included and integrated into society [1]. The Rehabilitation Act was amended in 1986 (PL 99–506), 1992 (PL 102–569), and 1993 (PL 103–73), with each amendment emphasizing the benefits of assistive technology (AT) as a valuable tool that can be used to improve the lives of individuals with disabilities.

The Assistive Technology Act was passed in 1998 and amended in 2004 with the explicit aim to increase access to, availability of, and funding for AT services and devices for individuals with disabilities so that they can fully participate in employment, education, and daily activities (PL 108–364, 118 Stat, 1709) [2]. AT was defined as “Any item, piece of equipment, or system, whether acquired commercially, modified, or customized, that is commonly used to increase, maintain, or improve functional capabilities of individuals with disabilities.” (PL 108–364, 118 Stat, 1710) [2]. AT services was further defined as “any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device” (PL 108–364, 118 Stat, 1710) [2]. The Rehabilitation Service Administration (RSA) defines rehabilitation technology (RT) as a systematic application of technologies, engineering methodologies, or scientific principles to meet the needs of and address the barriers faced by individuals with disabilities in areas such as education, rehabilitation, employment, transportation, independent living, and recreation [3]. The terms RT and AT are often used interchangeably and under an umbrella term that covers the systems and services related to the delivery of assistive products and services. Even if the definitions of RT and AT Public Law vary slightly, for this study, the terms are used interchangeably.

AT can be a valuable tool for individuals with disabilities to obtain employment, communicate with others, and perform work-related tasks more independently and effectively. Studies have consistently shown that the provision of AT services is significantly associated with achieved employment outcomes at closure for individuals with disabilities in VR programs [4–7]. The use of AT can increase productivity, self-esteem, hours worked, and attendance of individuals with disabilities [8], and is highly valued by VR clients for its impact on independence, subjective well-being, and work participation [9]. A systematic review conducted by Sauer et al. [10] demonstrated that AT could assist individuals with disabilities to perform job-related tasks with greater ease and independence. A recent systematic review [11] and meta-analysis [12] confirmed that AT improves several aspects of employment performance for individuals with intellectual and developmental disabilities. A number of studies also have demonstrated that providing video modelling and prompting through AT devices could significantly assist adults with autism to increase job-related performance [13–15]. Wearable technology has demonstrated promise for monitoring and prompting employees to complete work-related tasks; these types of supports were traditionally provided by on-site job coaches. Examples of devices include smartwatches [11], Bluetooth skin resistance sensors [16], computerized smart glasses [17], and Internet of Things devices [18].

Low-tech devices are any non-mechanical, non-electronic, non-motorized device that is typically manually driven, and has one or two particular features, such as canes, mouth sticks, manual wheelchairs, and optical magnifiers. In contrast, high-tech refers to modern technology that includes electronic components, and advanced, multiple features. Examples of high-tech devices include smart devices, such as smartphones, tablets, and other portable smart devices. As smart devices become increasingly popular and mainstream, they can be used as mainstream technology to help individuals with disabilities perform tasks and improve their employment outcomes [19]. These devices have a number of benefits, including no stigma or highlighting onof e’s disability in the workplace [20]. They are portable, adaptable, and offer a variety of application options [21,22]. The use of smart devices has become increasingly prevalent, with 85% of all American adults using a smartphone in 2021, compared to only 35% in 2011 [23], and 68% of American adults using a smartphone in 2015, up from 35% in 2011, and tablet use has risen to 45% among adults [24]. Smartphone, tablet, and laptop/computer users are more likely to be younger adults [24]. Kaye et al. [25] reported that the use of AT increases with age, particularly for low-tech devices, while the use of high-tech devices tends to increase with decreased age. Lockenhoff [26] pointed out that younger adults use an alternative-based strategy to evaluate choices based on distinct features. By contrast, older adults use an attribute-based strategy, making choices based on a particular feature. For example, Mitzner et al. [27] found that older adults perceived having many features within a device as a disadvantage. Connolly et al. [28] noted that, in comparison to older adults, younger adults are more likely to use a smartphone and describe this technology as being easy to navigate and use. Wang et al. [29] found that smart devices such as smartphones with cognitive apps were widely preferred and used by young veterans with traumatic brain injury to compensate for cognitive limitations. Randall et al. [30] suggest that using smartphone and other portable smart device with apps for young adults with cognitive limitations could be a feasible solution for improving employment outcomes. Smart device apps have been developed to address a range of cognitive functioning limitations associated with mental health conditions [31–33], such as emotional regulation, attention, planning, organization, concentration, executive function, time management, and working memory [34,35]. Other studies indicate that using virtual reality technology for vocational training can improve cognitive functioning and job interview skills for individuals with mental disabilities [36, 37], which can be adapted to smartphones and other portable smart devices as apps or software to help individuals with mental disabilities improve their employment outcomes.

A client-centered model, such as the Matching Person & Technology (MPT) Model and Assessment Process, can be helpful in optimizing the outcomes of AT services. Scherer and Craddock [38] suggested three essential domains: determination of the milieu/environment factors influencing use; identification of the user’s characteristics, needs, and preferences; and description of the AT characteristics of the most desirable and appropriate technology. The assessment process is both a collaborative and client-centered approach [39,40], involving the input and participation of the client and other relevant professionals, such as assistive technology professionals, VR counsellors, therapists, physicians, employers, and funding source representatives [20]. Different service delivery models are used in VR programs to provide AT services. Some VR programs employ AT specialists, while others use VR counsellors who have special responsibility for providing AT services. Others rely on comparable services and benefits providers outside VR programs to deliver AT services to VR clients [41]. The responsibility of the VR counsellor is to coordinate and authorize AT services through these various delivery pathways when reasonable, necessary, and appropriate for the client. Regardless of the service delivery model used, effective AT service delivery should be collaborative and involve a team of professionals, and the client is central to this team [20,42]. To ensure better service outcomes for the client, Scherer et al. [43] and Wessels et al. [44] emphasized the importance of addressing both the client’s functional and psychological needs. AT that is recommended or prescribed without input from the user is less likely to be used to its full potential [20]. Given that up to 30% of AT devices are not used or discarded by individuals within a year of adoption demonstrates the importance of including the user in the selection of the AT device [45]. Individuals with disabilities can improve their employment outcomes and other work performance outcomes if they are provided with the appropriate AT that is matched their needs, trained in its proper use, and received necessary work accommodations [46–50].

Despite the research evidence showing the benefits of AT services on employment outcomes [4–7, 51–53] and the legislation mandating improved access to AT for individuals with disabilities, previous studies noted that AT services are underutilized, particularly among individuals with cognitive and mental disabilities. Huang et al. [54] reported that only 10.4% of VR clients received AT services. Similarly, in Sprong et al.’s [4] study, only 8.5% of VR clients received AT services. Chen et al. [55] found that VR provided limited AT services for individuals with cognitive disabilities. Lee et al. [56] reported that less than 5% of individuals with psychiatric disabilities received AT services. Historically, access to AT services has been consistent across fiscal years for individuals with disabilities with certain co-occurring identities such as race/-ethnicity, employment status, education, age, income, and disability type and severity level [51,54,57]. The literature recommended more training on AT for VR counsellors [41,58–64]. These authors emphasized the importance of AT training in order to increase individuals’ access to AT services. Noll et al. [41] noted that VR counsellors are more likely to provide AT services when they have greater knowledge and training in AT. Similarly, Riemer-Reiss [62] found that training is positively associated with AT selection and referrals. The author further pointed out that many rehabilitation counsellors employed by state VR programs have not had sufficient AT training during their counsellor education or had received short-term training. In addition, curricular standards for rehabilitation counselling programs often have few and generic AT training requirements [63]. For example, the accrediting body for graduate-level rehabilitation counselling programs, the Council for Accreditation of Counselling and Related Educational Programs (CACREP), includes AT in multiple education standards for rehabilitation counsellor education. Standard 3 addresses practice dimensions of rehabilitation counselling and the “evaluation and application of assistive technology with an emphasis on individualized assessment and planning” (p. 36) [65]. Even though some in-service rehabilitation counsellors may choose to further their training and become certified assistive technology professionals (ATP) through the Rehabilitation Engineering and Assistive Technology Society of North America (RESNA), this is neither encouraged nor required for VR settings [64]. Furthermore, several barriers to AT access have been documented in the literature, including a lack of awareness of the benefits and availability of AT [25,55,66,67], policy restrictions for AT funding [68–70], and limited access for minority groups [71–76].

Given the growing body of evidence demonstrating the critical role of AT in achieving successful employment outcomes, we need a better understanding of why AT services are underutilized and why specific populations have less access to AT services. Recognizing potential disparities is the first step in improving equity in access to beneficial services. The purpose of this study was to identify sociodemographic factors which may act as barriers to receiving AT services in VR programs.

Method

Sampling and participants

This study is a retrospective analysis of national data collected by the Rehabilitation Service Administration’s Case Service Report over three fiscal years (2017–2019). Case Service Report is administrative data collected annually by each state VR program. The data produced from information reported by VR counsellors when each case was opened and closed, including information regarding demographics, disability, services provided, and employment outcome information [3]. Between the fiscal years of 2017 and 2019, a total of 1,495,096 cases were included in the database. Cases were excluded if the case was reported as ineligible for VR services, having no disability, under the age of 18 years, or had incomplete data. A total of 706,923 were excluded (Figure 1): 603,117 were deemed ineligible for VR services, 90,751 were <18 years old, 1219 were reported as having no disability, and 11,836 had incomplete data. After applying the exclusion criteria, 788,173 cases were included in the final sample.

Figure 1.

Diagram illustrates the selection process.

Dependent variable

The receipt of AT services was the outcome variable for the study. All AT services provided by VR programs or provided by comparable services and benefits providers for VR clients were consolidated into two codes: received AT services versus did not receive AT services.

Independent variables

We included sociodemographic variables commonly considered in disparities research: (a) gender; (b) age was stratified by three age groups: 18–44 years (young adults), 45–64 years (middle-aged adults), and ≥65 years (older adults); (c) race/ethnicity was classified into two categories based on minority status: minority (i.e. American Indian or Alaska Native, Asian, African, Native Hawaiian or other Pacific Islander, Hispanic) versus non-minority (i.e. White non-Hispanic); (d) highest educational level at application (i.e. special education, less than high school, high school, associate’s degree, bachelor degree or higher); (e) enrollment in post-secondary education at application (yes/no); (f) primary disability (auditory, visual, physical, cognitive, mental disabilities); (g) significant disability (yes/no: significant disability indicates a disability or combination of disabilities that seriously limits one or more functional capacities in terms of an employment outcome and requires multiple VR services over an extended period of time); (h) employed at application (yes/no); (i) low income status at application (yes/no: an individual is considered low income if he/she received the following assistances in the 6 months prior to application: assistance through the Supplemental Nutrition Assistance Program, the Temporary Assistance for Needy Families Program, the Supplemental Security Income Program, or individual is homeless or if their own total income or family income is less than the federal poverty level) [3].

Statistical analysis

We used descriptive statistics to report the number of individuals who received and did not receive AT services. We used logistic regression analysis with nine different sociodemographic variables simultaneously entered to examine the extent to which the sociodemographic variables were independently associated with the initial receipt of AT services. In the regression model, we used the entire sample of 788,173 that included all the cases with complete data. The odds ratios (ORs) and 95% confidence intervals (CIs) are reported. Before conducting the analysis, multicollinearity among the variables was screened. All correlations were <0.10, indicating that there was no multicollinearity among the variables. All statistical analyses were conducted using IBM SPSS Statistics for Windows (Version 26) with alpha = 0.05.

Results

Descriptive statistics

Between 2017–2019, 67,789 (8.6%) individuals received AT services and 720,384 (91.4%) did not. The group that received AT services tended to be older, with an average age of 48.3 years; standard deviation (SD)=16.3 years, while the group that did not receive AT services had an average age of 35.2 years; SD = 15.1 years. The recipient group were approximately 13 years older than non-recipient group. The recipient group had a higher proportion of women (50.6%), non-minority (70.5%), employed (60.9%), non-low income (69.8%), and have an auditory disability (53.2%). The non-recipient group had a higher proportion of men (56%), low income (53.4%), unemployed (84.4%), significant disabilities (96.4%), having a mental disability (37.5%), a high school diploma (45.3%), and not enrolled in post-secondary education (92.8%). See Table 1 for complete summaries.

Table 1.

Descriptive statistics.

		Receipt of AT services
Study variable	Total (n = 788,173)	AT-no (n = 720,384; 91.4%)	AT-yes (n = 67,789; 8.6%)
Gender
Men	436,959 (55.4%)	403,452 (56%)	33,507 (49.4%)
Women	351,214 (44.6%)	316,932 (44%)	34,282 (50.6%)
Age at Application (years)
18–44 (young adults)	522,911 (66.3%)	497,467 (69.1%)	25,444 (37.5%)
45–64 (middle-aged adults)	238,160 (30.2%)	206,387 (28.6%)	31,773 (46.9%)
≥65 (older adults)	27,102 (3.5%)	16,530 (2.3%)	10,572 (15.6%)
Minority status
Yes	324,009 (41.1%)	303,995 (42.2%)	20,014 (29.5%)
No	464,164 (58.9%)	416,389 (57.8%)	47,775 (70.5%)
Primary disability type
Auditory	87,021 (11.0%)	50,978 (7.1%)	36,043 (53.2%)
Visual	39,818 (5.1 %)	27,563 (3.8%)	12,255 (18.1%)
Physical	157,652 (20.9%)	146,585 (20.3%)	11,067 (16.3%)
Cognitive	229,355 (29.1%)	225,135 (31.3%)	4,220 (6.2%)
Mental	274,327 (34.8%)	270,123 (37.5%)	4,204 (6.2%)
Significance of disability
No significant disability	37,268 (4.7%)	25,653 (3.6%)	11,615 (17.1%)
Significant disability	750,905 (95.3%)	694,731 (96.4%)	56,174 (82.9%)
Education level
Special education	30,291 (3.8%)	29,440 (4.1%)	851 (1.3%)
Less than high school	207,624 (26.3%)	196,941 (27.3%)	10,683 (15.8%)
High school	352,882 (44.8%)	326,152 (45.3%)	26,730 (39.4%)
Associate degree	136,114 (17.3%)	119,482 (16.6%)	16,632 (24.5%)
Bachelor or higher	61,262 (7.8%)	48,369 (6.7%)	12,893 (19.0%)
Post-secondary education
Not enrolled	732,796 (93.0%)	668,457 (92.8%)	64,339 (94.9%)
Enrolled	55,377 (7.0%)	51,927 (7.2%)	3,450 (5.1%)
Income status
Low income	405,396 (51.4%)	384,937 (53.4%)	20,459 (30.2%)
Not low income	382,777 (48.6%)	335,447 (46.6%)	47,330 (69.8%)
Employment status
Employed	153,777 (19.5%)	112,502 (15.6%)	41,275 (60.9%)
Unemployed	634,396 (80.5%)	607,882 (84.4%)	26,514 (39.1%)

Logistic regression analysis

The full model, with receipt of AT services as the outcome, was significant, x²(16) = 152,874.8, p < .001, and explained 40% (Nagelkerke R²) of the variance. In the model classification table, the logistic regression model accurately predicted 93% of the cases in our sample (35% of cases that received AT services and 98% of cases that did not receive AT services correctly classified). All covariates were independently associated with receipt of AT services and the patterns largely followed the observed, unadjusted differences between groups. Odds of receiving AT services were greater for women, non-minorities, employed, non-low-income, enrolled in post-secondary education, obtained a bachelor’s degree or higher, auditory disability, no significant disability, and age ≥ 65 years. The results of the logistic regression analysis (the regression coefficients, Wald statistics, odds ratios, and 95% confidence intervals) are shown in Table 2.

Table 2.

The logistic regression results for predictors of receiving AT services.

				95% CI
Predictors	B	Wald	OR	Lower	Upper
Gender (ref: men)	0.087	81.4	1.091**	1.070	1.111
Minority status (ref: non-minority)	−0.212	419.8	0.809**	0.793	0.825
Employment status at app (ref: Employed)	−1.016	9085.9	0.362**	0.354	0.370
Income status at app (ref: non-low income)	−0.197	356.2	0.821**	0.804	0.838
Enrolled in PSE at app (ref: not enrolled)	0.182	78.1	1.199**	1.152	1.249
Education level (ref: bachelor or higher)
Associate degree	−0.217	187.3	0.805**	0.781	0.830
High school degree	−0.580	1599.9	0.560**	0.544	0.576
Less than high school	−0.606	1260.9	0.545**	0.527	0.564
Special education	−0.637	258.7	0.529**	0.489	0.572
Primary disability (ref: physical)
Auditory	1.739	17829.2	5.694**	5.551	5.842
Visual	1.611	11083.3	5.007**	4.859	5.160
Cognitive	−1.021	2755.1	0.360**	0.347	0.374
Mental	−1.356	5226.5	0.258**	0.248	0.267
Significance (ref: no significant disability)
Significant disability	−0.416	715.8	0.660**	0.640	0.680
Age at app (ref: ≥65 years)
18–44 years	−0.674	1498.7	0.510**	0.492	0.527
45–64 years	−0.383	518.7	0.682**	0.660	0.705

OR: Odds ratio; CI: Confidence interval; Wald: Wald statistics; B: Regression coefficients; PSE: Post-Secondary Education; app: Application; ref: reference category.

^**P < .001;

^*p < .05.

Discussion

The purpose of this study was to examine the extent to which sociodemographic factors predict the initial receipt of AT services and to highlight potential barriers and disparities in access to AT services. The first finding of this study is that only a small percentage (8.6%) of individuals with disabilities received AT services. Numerous studies [41,58–64] have demonstrated that rehabilitation counsellors are undertrained in AT services. This may explain why AT services continue to be underutilized in VR programs. Thus, there is a need for more in-service AT training for VR counsellors. RESNA trains in-service VR counsellors to become certified ATPs and offers AT training in assessing the clients’ needs for AT services, matching appropriate AT with clients’ needs, and providing training in the use of the selected AT for clients. In addition, there is an ongoing need to increase AT training in counsellor education, which may be the source of the current AT training deficiencies. Thus, AT training can play a role in assisting counsellors to become more comfortable and competent in AT services, hence increasing access and referrals to AT services for individuals with disabilities who require and benefit from such services.

While cognitive (29.1%) and mental (34.8%) disabilities outnumber other categories of disability in the overall sample of this study, individuals with these disabilities were the least likely to receive AT services. Despite the increased availability and development of devices, applications, or software that could benefit this population, it is possible that AT is not viewed as effective or worthwhile for improving employment outcomes by this population and their service providers [25,55]. An increase in knowledge and awareness about AT could potentially facilitate access to AT [67]. Funding for cognitive or mental disabilities-related technologies may be more restrictive than sensory or physical disabilities-related technologies. It is probable that a lack of client and professional awareness of technologies, restrictive funding, skills to assess this population’s needs for AT and empirical support on the outcomes of AT in vocational settings for this population are collective barriers that may stand in the way of this population’s access to AT services. Individuals who could potentially benefit from AT may not be well-informed about the opportunities that AT offers [67]. This can result in missing out on possible employment that would be accessible to them with the use of AT. Rehabilitation counsellors do not need to know everything about every technology; instead, they need to know what exists that may help their clients, and what potential clients’ needs for AT are. Counsellors with this information can continue their education on their own about the available technologies for their clients and be prepared to provide guidance and information as needed. The client and professional awareness of useful AT should have a positive impact on technology access and use [50], and thus on people’s employment outcomes.

Individuals 65 and older were more likely to receive AT services. This finding is not surprising given the impact of age-related performance declines, resulting in older adults seeking more AT services and devices at a higher rate than the younger population [25,54]. The finding also suggests that AT provided to older adults is often low-tech rather than high-tech or non-mainstream technology, which may be less appropriate to meet the needs of the younger population. This population’s perceptions of stigma or negative connotations linked with the use of non-mainstream AT may impact their decision to use AT in the working environment [20]. Due to the ability of the younger population to use smartphones and other portable smart devices [22,28–30], such mainstream devices with apps can be used to assist the younger population in performing job-related tasks, navigating employment-related challenges, searching for jobs, and other employment-related purposes. This population may not have access to such devices and/or may not be trained on how to use the features and apps available on their own devices. Thus, providing this population with access to age-appropriate AT and training on how to integrate/use them for employment would be beneficial in assisting this population towards achieving successful employment outcomes.

Individuals who were unemployed at the time of application were less likely to receive AT services. This finding is not surprising given that unemployed individuals have a lack of knowledge of job duties, types of work tasks, and familiarity with AT options that could be beneficial to use in the workplace [66]. Therefore, this population may derive limited information and benefit from an examination of their AT needs for employment [51]. For instance, applications, communication devices, computer programs, visual aids, and other forms of AT options, could help unemployed individuals to learn skills, perform job tasks, and obtain access to information and employment opportunities. In a recent study, Sprong et al. [4] found that unemployed individuals who received AT services had a significantly greater chance of obtaining employment than unemployed individuals who did not receive AT services.

Low-income individuals with disabilities were less likely to receive AT services than their higher-income counterparts. Arthanat et al. [63] conducted a survey of 318 AT providers and 88% reported that limited AT funding negatively impacts access to AT services. Likewise, Howard et al. [68] indicated in a recent meta-analysis that limited funding is one of the most significant barriers to equitable access to AT services. Even if individuals have insurance, many public insurances may not adequately cover AT because that requested AT may fall outside the concept of medical necessity [69,70]. AT for the purposes of improving function, empowerment, independence, and enhancing the quality of an individual’s life are not necessarily related to medical necessity, which results in difficult choices for both clients and AT providers [20,63,69,70]. According to Wallace [70], federal and state policies generally lack coordination with AT practical concepts such as individual choice, individual empowerment, and disability prevention, which are inherent principles for the implementation of AT solutions. Such policies have been driven by the medical justification for funding [70]. Arthanat et al. [63] noted that AT providers’ perceived competency was more evident when justifying eligibility for AT funding based on medical necessity, but not for functional, environmental, or personal necessity. Expanding public policies can help address the income-related gap in the cost of AT by offering AT that goes beyond medical necessity and enables individuals to fully participate in workforce. With supportive public policies, low-income individuals with disabilities can have access to AT, leading to increased employment opportunities, independence, and improved quality of life. On the other side, rehabilitation counsellors should identify alternative funding sources and refine eligibility criteria for low-income individuals, rather than justifying eligibility for AT funding solely on medical necessity. Without the support of rehabilitation counsellors, low-income individuals may be unaware of the funding streams or alternative options for funding.

Individuals with significant disabilities were less likely to receive AT services. Providing specialized technological solutions may be more difficult to prescribe, and/or those individuals may be expected to require extended services that exceed what VR programs would cover for this population. According to Sprong et al. [4], receiving AT services improved employment success for all individuals with disabilities, regardless of the severity of the individual’s disability. Not surprisingly, this population typically experiences more functional limitations, has greater complex needs, and requires specialized technological solutions than those without a significant disability. Thus, it should be noted that when conducting assessments, particularly for this population, a team-based approach is strongly recommended. The provision of AT service necessitates a collaborative approach when making decisions about assessment, acquisition, solutions, and overall service delivery [20,42]. The role of VR counsellors in the team approach is essential for identifying the needs of individuals with disabilities and developing a plan to assist them in achieving their employment goals. Working with other professionals to coordinate, purchase, and follow up on services to ensure that individuals receive the support they need, as well as discussing job accommodations and securing funding for individuals. This collaborative approach is not only the best practice but also ethical for rehabilitation counsellors. Teamwork and interdisciplinary team collaboration are included in the code of professional ethics for certified rehabilitation counsellors with one of the ethical obligations of the certified rehabilitation counsellor being to “promote mutual understanding of rehabilitation plans by all team members cooperating in the rehabilitation of clients” (p. 19) [77]. While VR counsellors are trained to assist individuals in fulfilling employment goals by matching the individual with the right job and accommodations, ATPs have specialized training and knowledge on AT to match appropriate AT with individuals’ needs for achieving employment goals. In the team, ATPs typically work with professionals to identify and evaluate the need for AT services, provide AT-related information and training on how to use AT for individuals, and discuss potential AT solutions with the team. Working within a team offers a mix of AT solutions, knowledge, and skills for delivering appropriate AT services to individuals with complex needs [42]. More research is needed to investigate the challenges and benefits of applying a team-based approach to the provision of VR AT services.

We found that individuals who are racial-ethnic minorities were less likely than non-minorities to receive AT services. Our finding aligns with other VR studies highlighting the limited access of minority groups in receiving services within the VR system [71–76]. In a recent study, Yin et al. [76] found that minorities apply for VR services at a higher rate than non-minorities but are less likely to meet VR eligibility criteria and thus, have lower rates of receiving services. In terms of education levels, having a higher education level increased the likelihood of receiving AT services. Our finding confirms other research concluding that more educated individuals are more likely to be aware of the benefits of AT, and to request resources and conduct their own research to learn about the appropriate AT solutions [25,54]. Women were more likely to receive AT services than men. This could indicate that women experience more functional limitations [78–81]. However, future research is needed to understand the influence of gender on the use of AT in vocational settings.

We found that individuals enrolled in post-secondary education were more likely to receive AT services than those who were not. This finding is not surprising given that the Workforce Investment and Opportunities Act of 2014 offers federal funds and regulations for VR counsellors to increase services to post-secondary students with disabilities who are eligible or potentially eligible for VR services [82–84]. In addition, VR counsellors would be able to identify the need for AT services from previous 504 accommodation plans or individualized education plans (IEP) of secondary education at application [4], thus including the AT service in individualized plan for employment to be provided by the VR program. The Rehabilitation Act of 1973 mandates the involvement of individuals with disabilities in the development of their individualized plan for employment [85]. VR counsellors can play a role in supporting students to lead their plans and encouraging collaboration to assess how their needs have changed since previous plans to best meet their needs. Moreover, assessing whether the AT solutions selected in prior plans are applicable or need to be modified to match the students’ vocational needs and goals.

Study limitations

Our study is not without limitations. First, this is a retrospective observational study that is subject to confounding by unobserved variables. Therefore, the findings cannot be used to infer causality. Nonetheless, this study identified significant statistical relationships between individual sociodemographic factors and the receipt of AT services. Second, the data have no information on the types of AT services (i.e. selection, acquisition, training) and AT devices (i.e. low tech, high tech). As a result, we were unable to identify how AT may vary across specific AT services and devices. Third, the data do not have information about the continued/discontinued use of AT services. Such information would highlight important information to improve the provision of long-term AT services. Fourth, the data do not contain individual identifiers. Therefore, we were unable to guarantee that the cases were not replicated over the three fiscal years. Fifth, data used for this study were collected from various VR programs at the national level and recorded by many VR counsellors, raising the possibility of data input errors.

Future research

Most studies on AT services provided through VR programs are retrospective. Prospective studies are recommended to identify practical solutions to the barriers identified in prior studies. For example, a qualitative study interviewing VR clients and counsellors could provide pivotal information on the underutilization of AT services. Future research should explore VR counsellors’ experiences in providing AT services in VR programs. This research could uncover practical problems and suggest potential solutions, which VR programs could use to enhance the provision of AT services. Furthermore, research is needed to investigate the challenges and benefits of applying a team-based approach to AT services in VR programs. Research on the effectiveness of existing and emerging technologies in improving employment outcomes and other work performance outcomes for individuals with mental health conditions and how to implement best AT practices in a practical and feasible manner for this population are worth investigating due to the dearth of research in this area. The inclusion of AT evaluation, coordination, and service delivery in rehabilitation counselling education is also a necessary area of future research.

Implications for rehabilitation

Despite the many studies showing that the provision of AT services positively predicts successful employment outcomes, they are underutilized overall, and there are apparent disparities in AT service utilization. Increasing AT training in counsellor education and offering more AT training for rehabilitation counsellors to increase their competence to serve individuals with diverse disabilities, particularly those with cognitive and mental disabilities. In addition to more pre-service and in-service training, VR agencies need to put more emphasis on the importance of their counsellors having skills in individualized AT evaluation, planning, and implementation to meet the unique needs of each client they serve. Counsellors should be encouraged to use a team approach to ensure the most effective AT solutions are provided. Increasing access to age-appropriate AT for younger individuals, as well as training on how to use them for employment and performing job-related tasks. Counsellors should identify alternative funding sources and refine eligibility criteria for low-income individuals, develop effective means for educating less-informed individuals about the benefits of AT, and recognise the limited access of minority groups to receive services within VR programs.

Conclusions

For individuals with a disability, access to AT can make the difference between not being able to work and having the necessary tools they need for successful employment. Both the Rehabilitation Act and the AT Act emphasize technology as a valuable tool, aim to increase the access to and use of AT among individuals with disabilities, and recognize the importance of AT services and devices for achieving employment outcomes. AT services provided by VR programs can improve employment outcomes and other work performance outcomes for many individuals with disabilities. Specific populations have less access to VR AT services. Our findings suggest that being unemployed, minority, having low income, having a significant disability, having a mental or cognitive disability, having less education, and being younger were significantly associated with a lower likelihood of receiving AT services. The findings emphasize the need for more research to identify underlying mechanisms and potential solutions to these apparent disparities in access to AT services for adults with disabilities.

IMPLICATIONS FOR REHABILITATION.

• Increasing assistive technology (AT) training in counsellor education and offering more AT training for in-service rehabilitation counsellors to increase their competence to serve individuals with diverse disabilities, particularly those with cognitive and mental disabilities.

• Counsellors should be encouraged to use a team approach to ensure the most effective AT solutions are provided, and improve access to age-appropriate AT for younger individuals.

• Counsellors should identify alternative funding sources and refine eligibility criteria for low-income individuals, and develop effective means for educating less-informed individuals about the benefits of AT, and recognise the limited access of minority groups to receive services within vocational rehabilitation programs.