Spring 2014: Cultural Accessibility

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Increasing Minority and Immigrant Participation: Lessons from an Adapted Sports and Recreation Program


Lisa Wahl of the Center for Accessible Technology looks back on her experience with the Bay Area Outreach and Recreation Program

African-American boy using a hand tricycle.
[Photo credit: Scott Goodman]
A BORP participant tries handcycling
Research shows that individuals with disabilities are much less likely to engage in a physically active life and are more at risk for preventable diseases and secondary disabilities. For those who also belong to a minority group, those risks are often amplified; persistent racial and ethnic health disparities, discrimination, and economic obstacles couple with environmental and access barriers to physical activity (Zawaiza et al., 2002). Between 2006 and 2009, knowledge of this “double jeopardy” spurred the Bay Area Outreach and Recreation Program (BORP) to conduct a minority outreach project. With the help of a grant from the RSA, BORP committed to multiple strategies to increase the number of individuals served from diverse cultures. Reviewing those strategies and their outcomes today provides insights worth sharing with the AT Program News community, and other initiatives seeking to benefit persons with disabilities of all cultures and ethnicities.
  1. Outreach to Community-based Agencies

    Each quarter, BORP staff conducted telephone outreach to over 100 community-based agencies that serve immigrant and minority individuals with disabilities in the Bay Area. Finding organizations that serve people of diverse cultures can be challenging, even in the Bay Area, as they are often informal groups without a listing or web presence. BORP found that the largest school district in the area had a group for Spanish-speaking special education parents and the largest health care provider had a Latina association. Their territory also has Latino-specific medical clinics, senior centers, and community centers. The adaptive PE teachers at schools were a valuable source of new referrals. In addition, BORP attended events such as the annual Indigenous People’s celebration.

    Despite the fact that BORP has been around since 1976, BORP learned that it took repeated contacts to remind other social service providers, educators, and health personnel to refer individuals for BORP’s recreational opportunities. The result of BORP’s persistence was more than 400 new client referrals over three years of which 95% became participants!
  2. More Staff Members and Volunteers from Minority Communities

    Outreach also produced opportunities for recruiting new volunteers. Over the course of the project, BORP attracted 38 volunteers with diverse linguistic talents, from local colleges (from groups such as the Southeast Asian Student Coalition, Hermanas Unidas, and the Asian/Pacific Islander Recruitment and Retention Center at UC Berkeley). BORP staff members were committed to following through, calling back new referrals who did not speak English with bilingual translators identified from within the community. Individuals were made to feel welcome and wanted by this commitment.
  3. Flexible Policies

    BORP recognized that for new referrals, having the confidence to participate in sports and recreation could require extra explanation, reassurance, and effort from staff. When recruiting new youth participants, staff members were willing to go and meet with families in their homes to explain how the program worked, address any questions and fears they might have, and put a human face on the new opportunity. Home visits also allowed staff to determine who made the decisions in the family and speak directly to their concerns. BORP learned that questions related to procedural details often masked concerns for how an individual with a disability will be perceived and treated by the program staff and others. Staff also saw issues related to self-confidence indirectly addressed through questions about program details. Recruiting required patience and new referrals were given multiple opportunities to get involved. BORP learned to build trust with families by inviting them to come watch and by generally being flexible.
  4. Free and Appropriate Transportation

    Although the Bay Area has extensive paratransit services, providing transportation or covering the cost of the paratransit services made the difference with participation in many cases. BORP buses could transport more wheelchair riders at a single time and could travel to recreational sites that were not served by public transportation.
  5. Recreational Opportunities Targeting Specific Minority Groups

    BORP programmed some recreation with the interests of specific groups in mind. One example was a delta boat cruise that toured an historic Chinese community. For some participants, activities that involved the entire family, such as camping and cycling, were the most effective. Money was clearly an issue for many who participated. One of the most successful BORP outings was a free camping overnight with all gear provided by a sporting goods company and a barbeque sponsored by the park. Trips involving ethnic foods also appealed to different communities.
How might this story apply to your AT program?

It took planning, commitment, and follow-through to achieve a substantial increase in the number of minority individuals served. Here are a few considerations to help your program get started:
  1. What organizations are minority individuals already patronizing in your community? Are there churches, social service agencies, ethnic or language-specific self-help groups or health clinics where you can talk to staff about your services and directly ask for appropriate referrals? Note: this is not a one-time effort!
  2. Do you have staff and volunteers who reflect the diversity you are trying to attract? Are there colleges or other programs that might supply bilingual volunteers? Remember to also recruit from new service users as appropriate. They may want to help.
  3. Are you willing to “see it through their eyes” in terms of orientation and intake?  The concept of an AT program may be completely novel and your orientation may need to be personalized for the value of what you offer to be understood. It may need to be delivered in a location where they already are, such as the home, a school, or a community location. If someone referred to your program can’t make it to your office, is there a way you can bring your service to them or assist with transportation?
  4. Are there opportunities to organize events that will appeal to specific communities? AT regional centers, for example, might consider inviting community leaders to a special open house to learn about AT and AT services. Also, are there existing community events through which your program can participate and network? In general, how might you begin to build new relationships?
Obviously BORP benefitted by a grant from the RSA to achieve its goal, but that experience changed program practices in a lasting way. Without new resources AT programs might start with one clearly defined strategy and a measurable goal, then make it a standing item on the staff meeting agenda, and after six months see where you are. After all, there is a lot of advice available on how to reach diverse communities, and it can be overwhelming. Which outreach strategy will get you started?

Candido Can!


Insights from an SLP in Massachusetts
Easter Seals Disability Services. MassMATCH: Maximizing Assistive Technology in Consumers' Hands

Recently, Kristi Peak-Oliveira, Co-coordinator of the MassMATCH AT Regional Center (ATRC) in Boston, met with Candido Surita in his home in Dorchester. Candido needed help with communication, specifically with options for augmentative alternative communication (AAC). Originally from Puerto Rico, Candido understands both English and Spanish, but now has ALS (a progressive neurodegenerative disease) and no longer uses speech. Kristi was referred to him once he'd begun hospice care by his exiting speech language pathologist (SLP). His health insurance would no longer cover SLP services, yet more than ever he needed a way to clearly communicate with family and other caregivers.
In addition to coordinating the AT Regional Center, Kristi works as an SLP for Easter Seals Massachusetts, the MassMATCH partner agency. For Kristi this is often a good marriage of roles and services. She can conduct an Easter Seals-funded AAC evaluation and demonstrate equipment from the ATRC short-term device loan program. Clients like Candido and family can borrow what they need to try for up to four weeks at a time. If they find equipment that works well for them, the ATRC will refer them to possible funding options from appropriate sources. Kristi, an augmentative communication specialist, is available for trouble-shooting along the way.
Initially, Kristi admits, she was concerned there wouldn't be the technical support at home for a voice output system to be successful with Candido. After all, Candido faces mounting physical challenges and using a speech generating device with a switch and, likely, automatic scanning would take problem-solving, family support, caregiver buy-in, stamina and patience. The home she was visiting was in a low-income neighborhood, and his primary caregiver--his sister--speaks only Spanish. The family had limited exposure to technology. Candido did not have a high level of education to start with and Kristi does not speak Spanish.
Through Easter Seals MA and the AT Regional Center, however, Kristi has experience serving a wide range of clients. In addition to Spanish speakers, there are Haitians, Cape Verdeans, Chinese, and others. Outreach is conducted through the Multicultural Independent Living Center in Dorchester as well as health care providers that serve diverse populations such as Tufts Medical Center and Brockton Hospital. Over the years, Kristi says, she's learned the best approach for meeting new clients is to presume competence from everyone. "I think it's easy for people to make assumptions based on education, race, socio-economic status," she reflects. "And I think the clients we work with must face that quite a bit in their lives. The last thing I want to do is make them feel that with me. So I assume competence, and try to be very, very respectful."
Assuming competence with Candido would prove highly appropriate. To his home Kristi brought with her an iPad with the new app, Proloquo4Text. While most of Candido's family members do not have a lot of experience with iPads, she discovered his 13-year-old nephew (who was present for the evaluation) does, and that his sister and hospice workers were more than willing to learn.
 Man in bed gazing at iPad mounted to side table.
Candido using the iPad for AAC

The app, Proloquo4Text, is designed with a keyboard for spelling while also providing access to whole phrases. One unique feature with significant potential for Candido is the option for a bilingual adult male voice; this means Candido can sound like the same person whether he is speaking Spanish to his sister or English to Kristi. To try out the app, Kristi set Candido up with a single pillow switch activated by squeezing his knees for use with automatic scanning. (Automatic scanning means that Candido does not have to navigate to the letter he wants at the onscreen keyboard, but can wait for his choice to be highlighted and then select it.*) The result, Kristi reports, was remarkable. "I have never seen anyone pick up automatic scanning as quickly as Candido! He took to it intuitively! I really didn’t need to do a lot of training with him before he was creating and producing messages.”
Kristi decided that given Candido's intelligence, desire to communicate, and extremely supportive family, this set up could work well. Through the ATRC's short-term device loan program, Candido is now borrowing an iPad, iPad mount, a Bluetooth adapter, and the pillow switch. She has additionally recommended the equipment be purchased for him through the Massachusetts Rehabilitation Commission’s Independent Living Program. "The road ahead for Candido and his family is very hard," Kristi reflects, "but they clearly love and enjoy each other, and are working together to support Candido. The AT equipment is giving Candido a voice, and they are so appreciative. Families like Candido's help me love my work."

* TECH UPDATE: Since this writing a tech glitch has emerged. iOS 7.1, the latest update, interprets the Bluetooth switch adapter as a Bluetooth keyboard and, therefore, fails to bring up the onscreen keyboard. Candido is currently using his switch to select whole phrases and other non-keyboard options only. Apple does not provide a way to downgrade to a previous version of its operating system. Kristi is looking into the Pererro switch adapter (not a Bluetooth) as a possible solution. Have another idea?  Please email Kristi Peak-Oliveira

Food for Thought

"The professional's first step toward cultural competence [...] is to become aware that he or she might have stereotypes or preconceptions about the person before him or her. Awareness is a complex skill gained over time. Only with greater cultural awareness can a person reject or avoid acting on the preconceived thoughts, obtain new individualized information and resolve the case with cultural competence."

From Common Myths about Cultural Competency and Diversity, a publication of the National Council on Disability

Proloquo4Text in Spanish... and Other App Options for Non-English AAC!

AssistiveWare logo.
There are a host of issues to consider when matching assistive technology to the needs, abilities, and preferences of an individual user. For augmentative and alternative communication (AAC) technology, hardware issues include touch screen sensitivity, switch compatibility, speaker volume, and portability. Software considerations include type-of-message creation (text-to-speech vs.symbols sets and recordings), options for displays and customization as well as the quality and variety of voices available for speech generation. Indeed it is inadequate to consider AAC software solutions based solely on the languages they support for speech and/or user interface. Yet without that functional cultural match, the other concerns may be irrelevant (particularly for literate users).

Unfortunately we have a long way to go before there is a full menu of AAC technology offerings in languages other than English. Those looking to localize existing AAC solutions, such as David Banes of the Mada Center in Qatar (who speaks about this frequently), observe there are different challenges to retrofitting AAC software in more languages: symbol sets are culturally-specific, not all languages read left-to-right, high-quality synthetic voices can be unavailable or very expensive. Even still, progress is being made. 

Proloquo4Text is one example. This is Assistiveware's new text-to-speech app for iOS devices designed for individuals who do not speak, but who do spell and use text to create messages. Its user interface is available in Spanish, French, Dutch, and German in addition to English. Natural-sounding (Acapela) voices are available in 15 languages (and include 95 voice options). Exciting for this continent is the latest U.S. version which offers the first-ever bilingual-American Spanish-English voices. Bilingual voices mean that individuals who use both English and Spanish can sound like the same person regardless of which language they deploy (there is an adult male voice as well as bilingual children's voices, both male and female). Proloquo4Text provides a customizable layout, word and sentence prediction (in 7 languages), access to whole phrases, social media sharing, and specialty voices (such as "bad guy" for humor!) Assistiveware first released Proloquo4Text last November, and version 1.1 came out at the end of January. Assistiveware also advertises multilingual support. The app costs $129.99 in the iTunes App Store. (Learn about the making of the first genuine children's voices for text-to-speech.

Assistiveware is also currently working on a Spanish- language option for Proloquo2Go--its symbol-based AAC app--and has plans to provide other languages as well. Pictello, Assistiveware's  visual story app, is available in Spanish, French, German, Dutch and Turkish. Learn more about Assistiveware's language options and plans.

In addition to Proloquo4Text, AAC apps worth exploring that offer Spanish and more include:
  • Touch Chat HD. A symbol and text-based full-featured AAC app that offers Spanish and Hebrew in addition to English. $149.99. iPad.
  • Tap to Talk. A full-featured symbol and text-based AAC app that provides text-to-speech in Spanish, English, Italian, French, German, Arabic, Danish, Dutch, Finnish, Norwegian, Portuguese, Swedish and Turkish. The user interface is English, however. Available for most phones and tablets (and computers). $149.99 for the Designer app. Free for the Player app.
  • Alexicom. Full-featured symbol and text-based AAC that is available for most devices in Spanish, English, French, German, and Italian. Free and paid versions.
  • ClaroSpeak offers text-to-speech in Spanish, English, Arabic, Bokmål, Norwegian, Danish, Dutch, French, German, Italian, Polish, Portuguese, and Swedish. The US version of the app offers high-quality (Nuance) male and female US-Mexican adult voices. $.99. iPhone/iPad.
  • Abilipad is a writing app that is also used for AAC. It provides Spanish, English, German, and French Acapela voices. $19.99. iPad.
  • Personal Assistant Communicator uses images and text to communicate in Spanish, English and French. Customizable. Free for iPhone/iPod/iPad (requires iOS 7).
  • Phrase Board is a text-based app designed by a registered nurse for patient communication. Available in Spanish, English, Arabic, French, German, Italian, and Swedish. Free for iPad.
Keep in mind that beyond text-to-speech, many AAC apps rely on recording messages and creating labels (or use images and symbols). So while there are a limited number of AAC apps programmed for non-English language users, many are used in any language even if the user interface supports English-only.

Reminder: AT Program News makes no endorsement, representation, or warranty expressed or implied for any product, device, or information set forth in this newsletter or on its Web site. AT Program News has not examined, reviewed, or tested any product or device referred to in this newsletter or at ATProgramNews.com.

Wanted: Your Web Accessibility Survey Questions

MassMATCH is interested in creating a survey to solicit user experiences with the MassMATCH website. Rather than reinvent the wheel, the program would like to consider questions other programs have asked on their own similar surveys. If your program has created a survey soliciting feedback on the accessibility/usability of a website, and you are willing to share your questions (not results), please email Kobena Bonney. Your input is appreciated!

Models of Outreach to Diverse Cultures


Do you know which strategy (or strategies) your program uses? Below is a roundup of outreach models to consider:

The community-based model: focus is placed on building the capacity of current community organizations; 

The grassroots model: often using indigenous native-speakers in venues not typically used by service organizations;

The train-the-trainer model: trusted community members are trained so that the community targeted for outreach maintains the needed knowledge after outreach workers have departed;

The peer-to-peer model: emphasizes the mutual understanding of contemporaries;

The partnership model: builds on the partner’s expertise and community trust, and

The support socialization model: couples outreach with popular events to attract the community.

Want to learn more? This list is adapted from
"Outreach and People with Disabilities from Diverse Cultures: A Review of the Literature," a National Council on Disability Cultural Diversity Initiative

AT Network Rethinks Outreach

AT Network: Assistive Technology...Tools for Living

Speaking of outreach strategies…AT Network in California reports success with their new Keep the Wheels Rolling Repair Fund. Through private donations and grants, the DME reuse fund is getting wheelchairs to more communities and raising general awareness of the AT Exchange and AT Network programs and services throughout California.

"We still conduct traditional outreach with translated brochures and tables at events," reports AT Network Program Director Kim Cantrell. "But this new reuse strategy is helping create partnerships in communities that we have not worked with before."

How it works: the AT Network provides small grants to established community-based non profits who refurbish donated wheelchairs. A non-profit can apply for up to $450 to repair a wheelchair so long as they agree to post the device on the AT Exchange (California's "Craig's list" styled reuse site of available AT). 

"The program means more organizations in more communities are participating on the AT Exchange," Cantrell emphasizes. "More people are receiving wheelchairs who would have no ability to do so without the program. We are providing something very tangible--expanding the capacity of existing reuse programs--and it's getting us noticed."

New Feature
Generation Tech!


Gaelyn Foster explains her essential campus hardware

Digital magnifier displaying text.
NOTE: Generation Tech is a new ATPN column featuring student writing about technology. Submissions are also welcome from educators sharing student work (and the tech strategies that helped inspire them). Learn more at Wanted: Student Writers (and their Educators).

Head shot of Gaelyn Foster
When I wake up for class every morning, the first things I do are dress, turn on the coffee pot and gather my belongings for the day. Gloomily, I begin to throw the necessary items into my overstuffed backpack. First the binders, folders and books, then the phone and the laptop. But lastly and most importantly, I unplug my eyes from the socket in the wall, where they have been charging all night. They sit next to my phone and my iPod in the front pocket of my tote, as if they were only another ubiquitous piece of commercial technology. I suppose on some level this comparison is accurate, but unlike a phone or an iPod, without my eyes I am as good as blind for the day.

My name is Gaelyn Foster, and I am a 19-year-old freshman at the University of Virginia. The set of “eyes” I refer to above is the term I’ve coined for my most crucial visual aid, the Nemo. The Nemo is a small, rectangular, hand-sized digital magnifier designed to assist the visually impaired in seeing close up reading materials. Discrete and easily handled, this gizmo is ideal for viewing labels, magazines, books, and the like.

Ever since I was introduced to the Nemo’s prototype in middle school, a slightly thicker and noisier gadget called the Quick Look, this machine has been a must-have item for me in my educational career and everyday life. While it does not help with long distance sight as a Flipper does, and does not allow for rapid near-distance reading as a CCTV does, the convenient size, discreteness, and portability make the Nemo advantageous. As I transitioned from middle school to high school, I found that the Nemo was by far the easiest gadget to carry. The elimination of toting unwieldy machines (the CCTV) from class to class allowed me to compromise neither my visual needs nor my punctuality.

Compared to the other portable models I have experienced, the Nemo has the most advantages. The image on the screen is crisp and clear, and the extendable handle makes it easy to control while working. A special memory drive can even be inserted to allow users to take pictures and record sounds. Though I have had trouble with the reliability of the on/off button on the side of the Nemo, occasionally refusing to power up or power down, I have found that removing and replacing the battery rectifies the issue. This is likely just a quirk in the make of the model.

Another feature which I not only appreciate, but also find vital in my everyday life, is the location of the camera relative to the rest of the machine. Unlike some newer models, such as the Peeble, the Nemo’s camera is placed at the end of the rectangular underbelly of the machine. Recently it has become more common to place the camera in the middle of portable magnifiers, which allows for easier space orientation, but terminates the ability to write under the machine. As I cannot see my own handwriting without the assistance of enlargement, it is crucial that the camera’s location allows for tilting the side of the machine upward to view what I am writing.

As a college student who walks several miles a day just to move from class to class, it is important that my visual aid be portable, versatile and convenient. I can say with confidence that my use of the Nemo, my “eyes,” over the years has allowed me to attend classes and operate in public no differently than most anyone else.

Student Writers (and their Educators!)


What is the Generation Tech column?

AT Program News is interested in how students with special needs (i.e. learning, sensory, and physical challenges) are using technology, and seeks to promote and help develop these first-person self-reflective voices with a column featuring their insights. Many 21 Century students are learning and engaging with curricula in entirely new ways, and students with special needs are among some of the earliest adopters of new technology. Generation Tech will feature writing by students (targeting grades 8-12 and post-secondary) who use technology to help them succeed academically. This may be with assistive technology or consumer technology.

Why Create Generation Tech?

The goals for the column are several:
  1. to create a real-world writing opportunity for students—the column has a real audience and serves a real need;
  2. to provide ATPN’s readership, including educators and families, with 1st person accounts of tech experiences used for academic (and in some cases social) gains—young voices can help readers learn what is possible in fresh and compelling ways;
  3. to allow students to consider expectations and deadlines outside of an academic environment and imagine themselves fulfilling such commitments beyond school—the beginnings of job readiness;
  4. to engage innovative educators who value writing for a real audience and/or are motivated to share student work alongside their teaching strategies and insights;
  5. to provide students the opportunity to list publication on their first resumes.

Content Ideas:

AT Program News serves organizations and professionals charged with providing access to the technologies that can improve quality of life for persons with disabilities including students. With this reach in mind, Generation Tech submissions might include:
  • Student Tech Reviews: Students write about the tools they like the best and why. Tech reviews should come from a personal perspective on technology. How does the technology help them succeed? Learn? Create? Participate? What do they want to tell others about their technology? What should other students who have had the same challenges know about this technology? What should professionals consider? (350-700 words)
  • Success Stories: Educators provide success stories of hard to reach students and include student content (this may be other forms of media beyond writing). Generation Tech will consider student content selected by educators that helps illustrate a student success (i.e. new capacity to create content, to express abstract thinking, to show what they know more effectively). These require companion submissions: one authored by the educator and one by the student. Success stories should also have a tech-driven component (software/hardware that helped the student engage).
  • Other Ideas: ATPN would like to hear from students and educators with their ideas for submissions for Generation Tech. This project is under construction and will evolve over time (and perhaps spin off to its own space).


Eliza Anderson, ATPN Editor-in-Chief
Download the Generation Tech Outreach Handout (for Educators) (WORD)
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