IMPACT OF EMERGING TECHNOLOGIES ON CHILDREN WITH DISABILITIES PAUL H WISE, MD MPH STANFORD HEALTH POLICY DEPT OF PEDIATRICS, STANFORD SCHOOL OF MEDICINE

HALFON, HOUTROW, LARSON, NEWACHECK … DISABILITY HALFON, HOUTROW, LARSON, NEWACHECK …

ASSISTIVE TECHNOLOGY “any item, piece of equipment or product system—whether acquired commercially, modified, or customized—that is used to increase, maintain, or improve functional capabilities or individuals with disabilities.”

AT EPIDEMIOLOGY AND NEED Limited evidence Primarily on communicative and mobility devices Generally improved child functional outcomes Little or no information on care-givers or family functioning Varying populations but substantial unmet needs for assistive technologies

EMERGING TECHNOLOGIES Nanotechnology Robotics Digital Environment

TECHNICAL INNOVATION AND SOCIAL DETERMINANTS OF HEALTH Tension between technical innovation and social determinants of health Historical tensions Disciplinary Integrated analytic framework Pivot on efficacy Dynamic Developmental complementarity

ACCESS MECHANISMS Child health care system poorly situated to provide assistive technology Mismatch of delivery system to need (medical home) Poor provider training Prospect of Medicaid contraction Early Intervention Educational System

DISPARATE DIFFUSION PATTERNS

IMPLICATIONS FOR DESIGN Accommodative (compensatory)--Orphan Universal

Summary Growing need Dynamic technologic environment—Growing Efficacy Blurred boundaries Deteriorating public commitment to provision of AT – Need for new delivery and financial structures