RESNA 26th International Annual Confence
Client Technical Services Department (CTS) in the Central Remedial Clinic (CRC) is one the few available recommendation services for AT in Ireland. With lack of funds preventing the set-up of AT service centres around the country, people with disabilities in the 1990's were forced to travel for AT recommendations and support to CTS in Dublin. This arrangement was found to be extremely unsatisfactory for a number of reasons. From the service users point of view
Over the past 5 years, CTS has worked on developing a client focused social and participatory service delivery model in AT. This has been built in collaboration with people with disabilities, based upon their needs and their experiences [2,3], One of the most evident needs was to both assess and deliver AT to people in their own environment. This lead to establishing an outreach service based on an ecological systems framework.  The focus of this paper is on the establishment of a new professional in the delivery of an assistive technology service. The following are the key points in establishing the position.
Critical components of a new initiative are relevance, readiness and resources.  Relevance was clear from previous action research , CTS had the capacity and need for change. CTS was successful in an application for European funding and support under the Horizon initiative to put in place the resources required to implement the program.
The key skills that are particularly relevant to the work of a TLO are good communication and interaction skills, and information and awareness of assistive technology resources. As one TLO succinctly expressed "To be aware of what's available and to be able to communicate that to others."
With the TLOs working directly with people at a local level and living in the area, they are able to relate the key problems users experience. They have found that the most common difficulty is the lack of information for potential users, followed by a lack of funding and assessment. They are also concerned about the lack of awareness on what is available, the lack of knowledge of how to use resources and the limited research into needs of clients
On the part of the TLOs and their relationship to others working in the field, two issues clearly emerged. Firstly there was apprehension about the attitudes and disposition of Heath Boards and health professionals, a number of of the TLOs recognised that part of their work would involve persuading other professionals of the value of their work within service delivery. Secondly, there is ongoing concern about a lack of funding for the necessary assistive technology. The TLOs cited building relationships with other agencies and services providers as a key issue for the future, however they also stated that there was an urgent need to increase funding through more lobbying and campaigning, that there was also a need to build positive images of people with disabilities, to increase awareness through education of the overall benefits of assistive technology.
"Being a wheelchair user myself scores massive points and made clients very receptive. They aren't just seeing another suit from the health board. The locally based nature and availability of the service is very important."
Regarding other service providers, he feels a number of professionals are still in the 'client robbing syndrome'. They are fearful of losing clients to another service and consequently their funding. In fact one voluntary sector organisation did not want anything to do with the TLO service. One TLO described many of the paramedical professionals as "tending to tell you what you need rather than ask. They are overly focused on the cost of Assistive Technology, rather than matching it to your needs. They see Euro (Dollar) signs rather than clients. If they were more open I think that it would be useful to work with them."
The future of service provision in AT requires professionals to work together and particularly with people with disabilities. We must look at what people with disabilities want rather than what we, as service providers, perceive what we think they need. In the words of Vic Finkelstein "What we need is a robust Profession Allied to the Community (PAC). With this fundamental shift, both in focus and alliance, PACs could freely develop in harmony with disabled people's aspirations.".
Manager Client Technical Services
Central Remedial Clinic
Dublin 3 Ireland firstname.lastname@example.org