Telehealth technology is making some big strides in closing the addiction treatment gap. A recovering opiate addict in rural Ohio now has greater access to Suboxone (an evidence-based Medication-Assisted Treatment for opiate cravings), thanks to videoconferencing technologies that allow them to meet their doctor in a “virtual” office. That same person in recovery can also access online behavioral therapies for substance abuse. And they can make use of recovery lifestyle apps and online support networks that provide the regular support and accountability they need in order to stay sober.
But more can be done to reach those who are still falling through the cracks—among them, people with disabilities. Many of these individuals in recovery will be suffering from one form of mental or physical disability or another: a co-occurring disorder like depression, attention deficit disorder, or post-traumatic stress disorder, for example; or a physical handicap that limits mobility or hearing or visual impairment. In such scenarios, the following checklist of usability standards may come in handy as a tool for determining what, if any, appropriate adaptive technologies may be employed to better serve the client.
- Is the client able (and comfortable!) using their hands and fingers to operate a typical keyboard and/or mouse, and if not, what’s the cause of that impairment? Different accommodations can be made, depending on the exact nature of the impairment. For instance, someone who only has movement in one hand may need a left-handed or right-handed keyboard; whereas someone with paralysis in both hands may need to use a mouth or head stick to control their keyboard.
- If a client has chronic and debilitating pain issues, these may also create discomfort with a traditional keyboard and mouse, in which case the client may do better with a “mouse alternative.” The term refers to a range of devices that can replace mice, from mini-joysticks and track pads, to a touch screen and touch computers, to software like Magic Cursor or Dragger, and more.
- Or, a simple problem of ergonomics may be limiting a client’s use of their hands and fingers. For instance, a wheelchair-using client may not be able to adjust their wheelchair to fit behind a standard computer desk. Here, too, there are assistive hardware solutions that can help.
- Does the client have speech impairment? If so, a number of adaptive technology options are available, depending on the nature and severity of the client’s impairment. If they can’t use their voice or their words are garbled, they may benefit from using a text-to-speech app or a voice synthesizer that, using software technology, in essence translates what they’re saying.
- Does the client have a visual impairment? A client who is blind may need a Braille keyboard. On the other hand, an elderly client with poor eyesight may need a keyboard with large print keyboard labels. If a telehealth session involves needing to read something on their computer screen, they may also need an enlargement of their screen display.
- Is the client able to plug the computer into a power source independently? Someone with a disability that limits their physical mobility—for example, a client who requires a wheelchair—will find it hard to reach certain power outlets. In such scenarios, they’ll need to use power bar strips with accessible “on” and “off” buttons.
- Does the client have basic computer literacy? The answer may be “no” on account of a number of circumstances. Maybe the client is elderly and never really had exposure to computers, or maybe they have a learning disability. In such instances, there are adaptive software solutions that can provide additional tutorial guidance and support. Examples include an alphabetical keyboard (with keys in the order of “ABCDEF” rather than the standard “QWERTY”) and installable software with simplified interfaces to email and other computer applications.
As a quick reference tool, hopefully the above checklist can help telehealth providers better serve the needs of clients with special needs. Those needs may be diverse, but thankfully so are the adaptive solutions.
Anna Ciulla is the Vice President of Clinical and Medical Services at Beach House Center for Recovery, where she is responsible for designing, implementing and supervising the delivery of the latest evidence-based therapies for treating substance use disorders. Anna has a passion for helping clients with substance use and co-occurring disorders achieve successful long-term recovery.