Redefining What's Possible

Introducing iNRRTS to Australian Clinicians | Ep 5 | Redefining What’s Possible

• Independent Living Specialists • Season 1 • Episode 5

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In this episode of the Redefining What's Possible podcast, host Sarah Uncle, Head of Clinical Education at ILS, is joined by Andrea Madsen and Weesie Walker from the International Registry of Rehabilitation Technology Suppliers (iNRRTS). Together, they explore the history and mission of iNRRTS, the importance of credentialing for Assistive Technology Professionals, and the global growth of professional standards in assistive technology. The discussion covers the benefits of certification programs, reducing equipment abandonment, and strengthening ethical practice. Andrea and Weesie share international perspectives, highlight emerging technologies, and close with inspiring real-life stories showing how assistive technology transforms lives.

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Welcome to Redefining What's Possible, your guide to Assistive Technology in Australia. Join us as we explore practical applications of AT featuring expert interviews and the latest industry insights to enhance your professional development and to improve client outcomes. Welcome to this episode of the Redefining What's Possible podcast. I'm your host, Sarah Uncle. I’m the National Clinical Education Manager from ILS, and I trained as an Occupational Therapist. And today, I am joined by two international guests. They are both from the International Registry of Rehabilitation Technology Suppliers, also called iNRRTS. And their names are Andrea Madsen and Weesie Walker. So Andrea is the executive director of iNRRTS And she has over 20 years of experience as a Complex Rehab Technology Supplier Professional, both with adults and with paediatric populations. She is a RESNA Certified Assistive Technology Professional and has held the iNRRTS CRTS designation and brings more than a decade of leadership through her service on the iNRRTS board of directors. And Weesie, Weesie is the former iNRRTS Executive Director, and the former CRT Supplier with over 25 years of experience providing Complex Rehab Technologies to children and adults. Weesie was an early NRRTS registrant and was awarded the Simon Margolis Fellow Award. So I want to warmly welcome you both to the podcast today. Thank you Sarah, it’s great to be here. Thank you Sarah. Yeah, you're welcome. And you guys are coming to us from the US, and it's late afternoon for you. And it's, you know, early morning for myself. So it's very different times of the day. And we've just sort of talked about the fact that it's winter here and summer there and kind of been opposites. But, for you to come and join us and spend time talking with us today, we really appreciate it, so, thank you. And so the first question I want to ask today, because a lot of our listeners would never have heard of iNRRTS before. It would be completely foreign to them. So I wanted to ask you to share the story of how iNRRTS, you know, used to be called NRRTS and was founded and what inspired its creation. Well, certainly, NRRTS was established back in 1992. In response to a lack of standards, lack of certifications and a lack of any type of qualification requirements for suppliers and the provision of wheelchairs and seating. So at that time, there were fewer equipment options, there were minimal documentation requirements, there were no complaint processes and no codes of ethics. Essentially anyone would be providing this critical equipment. So since its founding, NRRTS has been instrumental in setting and upholding high standards in the Complex Rehab Technology industry, and has continued to evolve, becoming iNRRTS in early 2024 to better reflect our International Registry of CRT Supplier Professionals. So which countries have you started working with beyond the US? We presently have registrants again in the US where we were founded, in Canada, in Australia and in Colombia. Fantastic. So I know with the CRT, so the Supplier Certification Program that you guys run, and I keep saying CRT thinking that all our listeners will know exactly what that means, that it's Complex Rehab Technology cause we don't often use that term here in Australia. But that's what we're talking about. So have you seen that support both new and experienced professionals in the field? Well, the Certificate Program that you're referring to is there's always been the need for it. And I was trying to give you an exact date, but I think it was probably 5 or 6 years ago. The board decided that it we just we were going to have to create this program to educate new people, bring them into the field. And there were two reasons, one was that there was a shortage of qualified people. And the other was that we were seeing a greater need for qualified people. And the board was convinced that our organisation was the best one to put this body of information, education together. And NRRTS has always been focused on education continuing education because that's what makes us the best at what we do, staying abreast. So, we developed this content with subject matter experts that were clinicians and suppliers. We worked with a professional learning design person to help guide us on how to set this up. And we, you know, as it has evolved we realised that we can't really consider ourselves a profession if there's no standardised foundation of knowledge that every person uses working with clients. And as my friend Jean Nangle who was one of our subject matter experts at the beginning, said it's to teach people to know what they don’t know. And that sounds maybe silly, but it's the truth. Because, every day you're learning something new, you're seeing something new, you know, being challenged with something new and no one can know it all. And so as a professional, you would be able to draw the resources that you need to help you get the best outcome. And that's how you provide client centered service. And that is the utmost importance. So important. And a lot of the clients we work with who require Assistive Technology, they are complicated, it's complex. And you're right, knowing that the people that are involved in the prescription of Assistive Technology to know they're credentialed. And they've been trained because it is complicated. And it's something that I want to take my hat off to iNRRTS for what they have put together, and I've been really lucky that I've been able to actually do the first six courses. And the quality of the education is so high. It is so useful and applicable. So it's really, it's enjoyable to complete. I've really enjoyed you know going through and a lot of it was just a reinforcement of what I already knew and a lot of it was new. And that's the thing, in this industry you're always learning, right? Like you don't stop learning. And so yeah, it's been a really really wonderful addition to my career is to be into it, and do some of that program. It's been wonderful, so thank you. So we've just been talking about sort of formal credentialing of Assisted Technology Professionals. How does that impact the quality of Assistive Technology service delivery for clients at the end of the day? Well, in my mind, I assume you've worked on both sides as the clinician and the supplier. And a supplier should offer the resources that make the team complete, right? Between the clinician and the client and the supplier. And so we focus on, giving people the medical terminology, understanding diagnosis, and how, some, you know, expected progression of diagnosis. And how you look at the environment of someone and make sure that the individual who's doing this understands that just because this person and this person have the same diagnosis, they may have very different needs. When it comes to environment, function, what have you. And so we're really focused on that individualised take your time, you know, do everything you need to do to make the best outcome for your client. Well, having had access to that type of training, it really does. It reduces errors, it reduces inexpensive, and long term complications that can be caused by improper equipment or improper fitting of equipment or a lack of qualified instruction in the proper use of equipment. So when you have someone who really has that understanding of how to marry an individual's goals and physical presentation and their lifestyle with the most appropriate equipment intervention, you end up having the best possible outcome. And that's what we all want, right? Like everybody in the room, that's our goal. We want the best possible outcome. And I know, like, here in Australia, we have a lot of issues with equipment being abandoned. Like, it just ends up collecting dust in the corner becoming a good clothes rack. Do you have the same sort of concerns there in the US or have you seen that with the credentialing that you have now? Have you seen that become a lot less because equipment is sort of more fit for purpose, really because of the people involved qualified and credentialed on what they do. Well, definitely. When you have someone who's able to fit the equipment appropriately, who is able to hear and understand the needs of the individual upfront going into the process. You have a lot less issue with equipment abandonment and you have a greater satisfaction from the client that their needs were met, that their needs were heard and valued, and that they're receiving ultimately what they want. Not just what we know is clinically the safest and most appropriate, but what they want and what helps them to reach their full potential. Yeah, cause sometimes their goals are different to the clinicians goals. And it's so important they are heard and that their goals, you know, what we all achieve like aspire to achieve. I think often our goals are a nice symmetrical posture. And someone else's goal is They just want to be able to get out in the community and have a good time, going out with their friends in their wheelchair and have independence. And you know, that's ultimately what our goal needs to be as well. Rather than clinically making sure everything looks perfect. Because it's not, you know, things aren't perfect. It’s not a perfect world. But the client's goals being number one focus is, in my mind, to the most important thing. Absolutely. And then I think if they abandon the equipment, it's on them, right? Because, you're giving them the final say. And that's an area that the suppliers need to know how to handle that. How to, you know, that when they don't agree with what you think is best, you know, how do you handle that? What's the best way to handle that? And that's important, very important. Yeah it is, and complicated too. Yeah, can be. So with the credentialing you've achieved, you know, with iNRRTS. How does that help uphold, like, ethical standards and professional accountability in the sort of Assistive Technology Provision in the industry that we're in. So, iNRRTS plays a critical role in upholding ethical standards and professional accountability in Assistive Technology Provision, particularly, within the field of Complex Rehab Technology or CRT. We achieved this through adherence to the NRRTS code of ethics, our standards of practice, and through our transparent complaint resolution protocol. Which together, this creates a comprehensive framework for responsible and ethical service delivery. Becoming iNRRTS registrant isn't merely a professional designation. It's a commitment to ethical conduct, to evidence based practice, and accountability. Which gives stakeholders, especially the people who are relying on Assistive Technology. The confidence that their provider is qualified, principled, and subject to ongoing oversight, which helps to safeguard the integrity and quality of their service delivery. It's wonderful. And you know what? I'm thinking about everything you're saying and the need for that here in Australia. So if you look at the credentialing landscape in Australia versus the US, what do you know about what we have here in Australia versus the US and what opportunities for growth do you see in Australia? Andrea and I discussed this earlier, and I wanted to share with you that I live in Georgia. In LaGrange, Georgia. And before NRRTS, there were no standards, as we've already addressed. And in the states, every state has a Medicaid Program that covers disabled and elderly population. And so we work very closely with that program. And the program director learned about NRRTS I would like to take credit for this, but that wouldn't be truthful. She learned about it on her own, and she wrote it into her policy that any CRT Supplier in Georgia had to be a NRRTS registrant. And it was a first day in the US to adopt that. And so my own personal experience, this is what I saw. There was a lot less fraud and abuse. There was a it brought all the suppliers together in a network that we were all part of the registry. And so we got to know each other and we would meet at certain times to discuss issues, but, more importantly is that the Medicaid Program looked at us as a resource, and we are. We’re a great resource. But people don't always see it that way. And so for one example, they decided they wanted to cover standers for children. And you know, the range of pricing is from a few hundred dollars to thousands of dollars. And they didn't know what, you know, what made one better than another. And so who did they call? Us. And we would bring the product in, show it to them, go over it. And it was a wonderful experience for everybody. And I really felt like we were all on the same page. You know, we're trying to preserve this precious funds that we have. You know, and not waste it but get people what they needed in the highest quality products. And that was, about 25 years ago. And it's still that way today. Obviously, the landscape of suppliers has changed tremendously. There aren't all these small providers anymore. But it’s still, it's the idea that, you know, we are all in it together and we're working together and we have a common goal that we're trying to achieve. And I think a lot of great board members for NRRTS have come from Georgia. And as people got involved, you know, and I will share this. At first people were like, you know, one more thing I have to do. But once they got involved in it and saw how it benefited them personally with all the education that we offer, it's slowly opened people's eyes and I wish that we could do that everywhere. Because, when people don't get the best outcome, they don't always even know they're not getting the best outcome. And I think that's sad. It's kind of sad. The Medicaid Program they would also, sometimes they would be looking at something that was submitted for approval. They may not fully understand what, you know, what the components are or what it would do. And they could, take all the pertinent information off of it and send it and have one of us just look at it and say, you know, does this look right to you? Yeah. Very much. So, becomes a real team approach, doesn't it? Absolutely. So here in Australia, we don't have any formal credentialing required for our Assistive Technology Professionals. And hearing the benefits of what that's done in the US, just makes me think that surely in the future it's going to be the way we're going to go as well. Of course, it has to. It has to. Yeah, it has to. So in terms of emerging trends or technologies in our industry in Assistive Technology. What are you most excited about and what do you foresee changes coming globally in our industry in years to come? When I think about this, I initially get excited about that the integration more broadly available technologies. For example, Bluetooth being applied to Assistive Technology, specifically within CRT. Allowing users to have greater access to their home environments, to the devices in their home without the barrier of having, you know, multiple interfaces or multiple switches or things that are harder to access and reducing those barriers and increasing their functional independence. But I'm also very excited about, as we were talking about the Australians who have joined our iNRRTS community and bringing together sort of this global community. AT, CRT, Professionals Suppliers. To be able to share their challenges and their successes. To be able to share their insights and education. I think is something that I'm most excited for. To be able to kind of share all of these things that are common between us. We might have different geographic areas we serve, different ages of populations, maybe a little different product offering. But at the end of the day, when we're working to improve the lives of individuals, we're all kind of fighting the same battle, seeing the same challenges. And it's great to be able to share those things and really be able to help and support one another. Absolutely. Is there anything else you wanted to add, Weesie? In terms of what's emerging. Again, Andrea and I talked about the sort. I've been out of the field for almost 12 years now. So, I'm not up on technology. But I do think that, an opportunity to view all the diagnose problems with chairs, you know, online or what have you. It's that significant. And hopefully we'll start seeing more crossover from our all this technology that we use every day. You know, can crossover into the our field a lot of it has, I know. And just the exciting I did a lot of alternative drive, power chairs and I do if I'm in an exhibit hall, I'll go by and just take a quick. You know, I don't need to know all the detail, but I just, I think everything is very exciting right now. And one of the things that we teach in this course is that really it's our imagination that limits what we can do for people. And you know, I've seen some really creative things come about from a particular person's need. And I don't know anything that could be more rewarding than having the capability of providing that for someone. And whether it's from your own effort or the team that you assemble to get that person what they need. And as you know, all the 20 something years I provided CRT. You know, a lot of those people I worked with the whole 20 some odd years. You know, you develop that relationship with people And that’s been, it's an amazing benefit to what we do. And that's why the job satisfaction, right? Like it's the best when you've worked with someone for 20 years and you've seen that your work has improved their quality of life, and they become your friends. That's so rewarding. And I love that about our industry, it's so rewarding. It's hard and challenging sometimes, but gosh, some days it just feels so good to go to work. It really does. Yeah, that's so good. So, for the OT’s and the physios. So you call them PT’s here in Australia, who the ones that passionate about advancing their practice with Assistive Technology. What advice would you give them in terms of the credentialing that we're talking about? And working with suppliers? I think you offered some excellent advice when you talked about the Certificate Program. Because, in the US, they’re obviously clinicians will start off working on the clinical side and then come to the supplier side. And you can appreciate that the knowledge base is similar, but there are other things that you need to understand and what your role is, and what the processes are. And so whether the clinician is just working with a supplier or wants to be a supplier or see, you know, a glimpse of, you know, what the supplier needs to know, and they should not. How can I put this, They should hold that supplier to a higher standard. I guess, is what I’m saying. And sometimes, that’s difficult to do, right? But there are ways to offer, you know, help improve somebody's skills. And you know, when I've started, they just come out of the wheel and I started providing wheelchairs back in the day. But it was the therapists that I worked with that taught me the things I needed to know. I didn't have a clinical background, and I was fortunate in that they didn't get aggravated with me. They just tried to show me, you know, what they were looking at and explain it to me. And that's how I learned and learned and learned. And so all that was we tried to put into this course, in a more concise manner in a good order that made sense to you. And you know, and so that. What took me ten years to learn, you can learn in that course, right? And so when a clinician they're kind of the advocate for their patient or their client. And they can't lose sight of that working with a supplier. If the supplier’s not doing the right thing, you know, take them aside, have a conversation with them. Say, hey, I know we can do better than this. And as a supplier, you should take that as a, opportunity to learn more. I need to learn more and as we all know. You can learn something new everyday, doing this. Yeah, that’s true. On the podcast, we usually have a closing question that I want to ask for both of you to answer. So that question is, can you describe a moment when Assistive Technology significantly changed a client's life, and how it inspired you to think differently about your work? So I have thought about that, and it's over the 20 years out in the field. A lot of faces pop into my head. And a lot of things I remember. And some of the ones that I felt like were the most impactful were over the smallest tasks. I remembered a little boy that I helped. I was setting up and fitting him for a mobile stander and as soon as we had the support set, I didn't have to remind him. You know, there's your breaks. Here's how you access your wheels. He was gone, and he had taken off through the kitchen, into the pantry so he could go get himself a snack, because he knew where they were and he knew where they came from. But he always had to wait for somebody else to meet that need for him. And he was so proud that he could just go and do that for himself. It made me think of another lady who, we were delivering and fitting her standing powerchair, and she drove into her kitchen and looked into the kitchen sink, and she started to cry. Because her kids had left dirty dishes in the sink, and she was so excited that she could see them and she could help clean up. And it sounds like these are small things, but these are things that they thought they might never get to do or ever regain. And it was profound for them to have those things back that many other people probably just take for granted. Yeah. So good. The simple things that we all take for granted. That make a really big difference to someone's life. How about you, Weesie? Yeah, it was Andrea’s. So, I thought of a lot of them. And here's one that is, one of my all time favorites. Was a little girl in an early intervention program in the school system. And we had been doing a lot of, trials with head arrays for children. And I had video, I had taken video of one child and brought it into the therapy office to show the clinician, and the little girl is in there. And this is a child that they thought she had visual impairment. They weren't sure about her hearing. And she, you know, she wasn't mobile at all. But apparently she watched the video that I had of her classmate driving this chair. And when it was her turn to do a trial, she just, she already knew what to do. It was really, I’m getting goosebumps just thinking about it. She went on, she was an independent driver She used a head array, she used a communication device. She graduated high school. She was an honor student at all that. But the thing that was her mother telling me years later, she said, yeah. She said, you know, when you and that therapist talked about putting Ashley in a power chair, my husband and I, we thought you all were crazy. And I said, why didn't you say something? And she said, well, we just we figured you all knew what you're doing. And so, you know, thank you for that confidence. That being able to be, you know, give that kid that key that simple thing that they need that unlocked, you know, her whole world. And as you can imagine, we became best friends. Throughout her school career. And I'm sitting here right now wondering what she might be doing now, you know. And there's, there are a million other stories, but that that kind of says it all. And that's what we mean by job satisfaction, right? Like that is. That is amazing. I want to thank you both so much for your time today, and for coming on and sharing your expertise and sharing your experience with us. And if we've got OT’s or physios who are listening to this that really interested to know more around iNRRTS and the program is spoken about how can they find out more. Is that do you want to go through just the website they can go to? Absolutely. They can come check out our website at www.nrrts.org We have information there on our continuing education, on CRT Supplier Certificate Program, as well as information within our directions magazine, the Journal of Complex Rehab Technology. And under our “about” and “meet our staff”. Our contact information is listed there. So please feel free to reach out with any questions. Fantastic. Well, thank you both again. And I want to say thank you for joining us on the podcast today. And we will catch you in the next one, bye.