RESNA 27th International Annual Confence
Introduction to Assistive Technology Data in the RSA-911 Case Service Report for Application to Assistive Technology Outcomes Measurement
The ATOMS Project is a five year project investigating the development of a next generation assistive technology (AT) outcomes measurement system. As part of this investigation, the project team is looking at existing data sources, instruments, and collection/analysis techniques. The RSA-911 (Case Service Report) data set is collected by the Rehabilitation Services Administration (RSA) of the United States government. It is a compilation of data submitted annually by state vocational rehabilitation agencies that reports all case closures during a given fiscal year. Each data record (case closure) contains an assortment of data fields specified by the RSA. These fields contain some rehabilitation technology data, which is defined to include provisions of assistive technology devices and services. This paper provides a brief overview of the RSA-911, the AT outcomes related data it contains, and the ATOMS Project's plans for further investigation.
1) assistive technology, 2) outcomes, 3) RSA-911, 4) ATOMS Project, 5) vocational rehabilitation
The ATOMS Project (Assistive Technology Outcomes Measurement System) targets the definition and pre-development phases of a next generation assistive technology (AT) outcomes measurement system. As part of the needs assessment phase of the project, the team evaluated clinical and national databases related to assistive technology (AT). In discussion with the Project's partners and the Wisconsin Division of Vocational Rehabilitation (DVR), the team became aware of the data set known as the "RSA-911" or "Case Service Report" (1). The database became of particular interest because of its content and because it is a national standard for states to follow, regardless of the structure of their vocational rehabilitation system. This paper briefly describes the RSA-911 data set to create awareness in the AT profession, which often works in the vocational setting, and to convey the ATOMS Project's plans, as a national project, to investigate this data further.
The RSA-911 report is submitted annually for the preceding fiscal year by each state's vocational rehabilitation agency (1). If the state has more than a central VR agency, such as those set up to specifically serve individuals who are blind, that state may submit multiple reports. The report contains a record for each case closure that occurred in an agency, regardless of the reason for closure. Therefore, because case closure is the trigger event, it is feasible that a consumer: 1) may not appear in the report in a given year, even though they received VR services during that year or 2) an individual may appear more than once in one year, if they had cases closed on two or more separate occasions during the fiscal year.
The RSA-911 aggregates many variables of outcomes related information, including demographics, disability, interventions, reason for closure, employment status, sources of financial support, and more. The values of certain fields (e.g. income, hours worked per week, etc.) are reported both at application and at closure. Of obvious interest to this project is that "Rehabilitation Technology" is one of the interventions tracked. This category currently includes, "Rehabilitation Technology Service", "Assistive Technology Devices", and "Assistive Technology Services" (3).
The fields in the RSA-911 that record performance at two points in time also make the report of particular interest because it mirrors the ATOMS Project's key concepts related to AT outcome measurement (2). That is, it is at a minimum essential to consider and collect both "ingos" and "outcomes" data and that these types of data are related in a theoretical framework. In this framework, assistive technology interventions are one type of ingo variable, and the impacts of the intervention are determined through changes in performance measured before and after the intervention, and through techniques to isolate the variable from other ingo variables.
Information was initially collected in this investigation through discussions with the State's vocational rehabilitation program, the Wisconsin Division of Vocational Rehabilitation (DVR). Wisconsin DVR staff provided a summary of how they extracted data from their active client database (IRIS) into an off-line database, and then used that database to produce the RSA-911 report to be sent to RSA. DVR also provided portions of the RSA policy directives (1, 3, 4) that detailed the RSA-911 data.
As a result of the Project's interest in the database, a literature search was done to locate other studies of the RSA-911, using the assistive technology data as one of the criteria. Though many studies were found that use the RSA-911 data, in whole or in part, none were found that focus specifically on the AT data component. The search included web-based search engines, such as Google.com and Altavista.com, and on-line research databases, such as Medline/Pubmed and Ebsco Host. Most articles that reported on studies involving the RSA-911 focused on a particular disability group, demographics (e.g. gender, race), trends in income, etc. but did not report investigating the rehabilitation technology fields.
Review of the policy directives (1, 3, 4) revealed several interesting points about the data collection and assistive technology. First, data fields for Rehabilitation Technology were first specified in the Case Service Report starting in 1995 with Policy Directive RSA-PD-95-04 (1). Second, new specifications for the RSA-911 were released as RSA-PD-00-06 in 2000 and went into effect for the fiscal year 2002 report (3, 4). Third, along with many other fields, the Rehabilitation Technology data fields were changed with RSA-PD-00-06 (1, 3).
The RSA-PD-95-04 defined the category Rehabilitation Technology and collected data on whether the sub-categories Rehabilitation Engineering, Assistive Technology Devices, and/or Assistive Technology Services were provided during the case. Under RSA-PD-00-06, these three items were then bundled together into one service called Rehabilitation Technology and moved under the Services Provided category. Instead of collecting data on provision of the individual sub-categories for Rehabilitation Technology, data is now collected on the type of vendor that provides Rehabilitation Technology (if applicable) and what the source of funding was (if applicable).
A notable design of the RSA-PD-95-04 database specifications is that if an individual received "Assistive Technology Devices", it was automatically assumed in the data that they also received "Assistive Technology Services", which many AT professionals would likely agree is not always a valid assumption.
Basic descriptive statistics were done on the fiscal year (FY) 2000 data. The results revealed the magnitude of this national data set.
This descriptive information reveals that AT devices were provided in approximately 6% of the case closures and that rehabilitation engineering was provided in approximately 1.5% of the case closures.
The following summary of findings has promoted further investigation into the use and content of this large national data set.
The data set's content, including specific AT fields, national coverage, and uniformity make it an interesting and relevant for AT outcomes investigations. Though the RSA-911 report lacks specificity in terms of interventions, it appears that it is a valuable source of data for AT outcomes studies. It is unique in that it has a large number of records (over 600,000) and that the data format is standardized nationwide. This database alone may be able to provide some insight into the outcomes of AT devices and services.
As the result of this work the ATOMS Project has planned several investigations related to this data set. Dependent on the findings, attempts may be made to influence public policy in terms AT outcomes data collection in the state/federal vocational rehabilitation setting.
This work is supported in part by the National Institute on Disability and Rehabilitation Research (NIDRR), grant number H133A010403. The opinions contained in this paper are those of the grantee and do not necessarily reflect those of NIDRR and the U.S. Department of Education.