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The Range Exchange: a rural assistive technology outreach program by extension homemakers.

The RANGE EXCHANGE, a pilot project recently conducted in five counties of Eastern Montana, is a community-based outreach program aimed at providing information on assistive technology to people with disabilities who live in rural Montana. The program is jointly sponsored by the Research & Training Center on Rural Rehabilitation Services (RTC:Rural) at Montana State University (MSU) and at the University of Montana and the MSU Extension Service. The Mission of the RTC:Rural is to improve the daily lives and enhance the independence of people with disabilities who live, work, and recreate in rural America. As part of this mission, the RTC:Rural believes it is important to improve prove access to information on assistive technology and to increase the awareness and knowledge of assistive technology for consumers and rehabilitation personnel. This article describes the concept, implementation, and results of a pilot project to meet these objectives.

The Problem

Overall, people living in rural America are less healthy than their urban counterparts (Reczynski, Tibbs, & Turk, 1987) and perceive themselves in this way (National Center for Health Statistics, 1984). Indeed, injury and disability appear to be more prevalent in rural areas. For example, Baker, O'Neill, & Karpf (1984) found that unintentional injury death rates for rural areas was twice that of the 58 largest cities. Contributing to the incidence of disabilities in rural areas is the fact that the two leading causes of work-related disabilities are found in primarily rural, resource-extraction occupations such as forestry, agriculture, and mining (Matheson & Page, 1984; Reczynski et al., 1987).

When a person living in rural America experience a disability, he or she faces many questions. How will my life change? Will I be able to return home? Can I still work? Do I need assistive technology? What types are available? Are the affordable?

A national study of the needs of adults with disabilities living in rural areas found that their top rated problem was the lack of affordable assistive devices consumers needed (Seekins, Jackson, & Dingman, 199). Similarly, Omohundro, Schneider, Marr, and Grannemann (1983) noted that in rural areas assistive devices were are, unsophisticated, and of limited value because the general physical environment was inaccessible.

Rural populations are no less isolated from these questions and rehabilitation problems than their urban counterparts. What makes them unique is that they are most isolated from the solutions. Unfortunately, the special needs of rural Americans with disabilities for both human and technical resources far exceed the current ability of rural rehabilitation resources in this country to meet those needs (Matheson & Page, 1985). Richards, Frieden, Gerken, and Veerkamp (1984) found that independent living for many people with disabilities in rural areas is characterized by significant problems associated of human and medical services, massive inaccessibility, and limited financial resources to obtain social services.

One solution to the problem of accessing assistance technology from a rural area involves reorienting generic service providers already in rural areas to build the capacity to address such problems. Marrs (1988) has argued that people living in rural communities sincerely care about one another and are usually willing to assist those in need; they know each other, depend on each other, and will even care for each other in times of illness or disability. Such arguments have been supported by research, such as a study that found 63 percent of respondents stating they could still count on others to help when needed (MSU Agricultural Experiment Station, 1988). Thus, volunteerism and grassroots organization are an integral part of the rural culture (Marrs, 1988). It follows that these groups could be viable elements in a network organized to meet the information needs of people with disabilities in rural areas.

Certainly, it is common for rural populations to access a broad spectrum of generic service providers. These generic providers include diverse community members, such as a country extension agents, social workers, and clergy. These are trusted and accessible professionals who have advised rural residents on issues such as crop rotation, health care, financial assistance, county fairs, and marital problems. Although these advisors are unlikely to have knowledge or information about assistive technology, people with disabilities are likely to contact them because they don't know where else to go for this information.

This article reports the development of a rural outreach project involving the MSU Extension Service and its associated Extension Homemaker Clubs and in Montana. First, the organization of The RANGE EXCHANGE is described. Second, results, from a pilot test are outlined. Finally, these experience are discussed in terms of impact and consumer empowerment, as well as the reorientation of the Cooperative Extension Service toward supporting rehabilitation.

Organizing The

RANGE EXCHANGE

Montana as a Case Example

Much of the rural population lives in the "frontier countries" of the West (Popper, 1986), where the average population density is less than six person per square mile. For a person with a disability living in these or other rural areas, the concept of "choosing between services or service providers is a laughable concept, getting any service at all is the critical question" (Tonsing-Gonzales, 1988).

Montana provides a good example of the scarcity of rehabilitation resources in rural areas. The 17 most eastern countries of the state comprise Region I of Montana's Human Services Service System. This service region has a total population of 98,000 and a land area larger than the state of Indiana. The largest community in Region I has less than 10,000 residents. An estimated 11,300 people living in Region I have disabilities (based on a national prevalence rate of 11.5 percent in the general population). Region I is served primarily by one vocational rehabilitation office. In contrast, however, it should be noted that 52 of Montana's countries and one Indian reservation are served by at least one country extension agent. In addition, many countries are served by booth an agricultural and a home economist agent.

The Cooperative Extension Service

The Extension Service was created in 1984 by the Smith-Lever Act to "provide informal, noncredit education for the purpose of assisting people in making their own decision" (Warner & Christenson, 1984). The Cooperative Extension network operates in each of the 50 states and in four territories and is well-respected and trusted by rural populations. The Extension Services are based in the land-grant universities, a natural location for education outreach programs. The Extension Service mandate is not restricted to dealing only with problems of the farm and home but encompasses all rural community issues.

The credibility of the Extension Service during its 70-year history is due, in part, to "its responsiveness to local needs and priorities" (Warner & Christenson, 1984). "Probably the major strength that Extension has going for it is the perception, at least among its own clients, that while governments is something out there somewhere, Extension is local and responsive" (DeMarco, 1980). Federal, state and local governments all share in the control and support of the Extension Service. Approximately 67 percent of the 17,000 extension personnel are employed at the county level as county agents. Another 22 percent are subject matter specialists at the state land-grant universities (Warner & Christenson, 1984).

The Extension Homemakers are a volunteer organization within the Extension Service. The mission of the National Extension Homemakers Clubs is to strengthen families through: leadership development; continuing education; volunteer community service; and support systems at local, state, national, and international levels. Referred to as the movers and shakers of the world, the Extension Homemakers are a volunteer force of 4,400 in Montana alone and 500,000 nationally. Montana Extension Homemakers are organized into 287 individual and autonomous clubs. The Extension Homemakers are primarily nature women who have a long history of volunteerism and the largest nonclassroom adult education network in the world. Many Montana Extension Homemakers live in the most rural regions of the state and the family roots in Montana that span several generations.

Service-oriented Extension Homemaker projects are classified into eight categories: citizenship; cultural arts, textiles, and clothing; family life; family resource management; health, food, and nutrition; housing, energy, and environmental; international outreach; and safety. Most Extension Homemaker projects deal with disseminating information, although the scope of projects is not restricted. For example, the Volunteer Information Provider Program (VIPP) piloted at the University of Missouri in 1986 involved Extension Homemakers and was created to educate the caregivers of frail and impaired elderly people through information sharing and knowledge acquisition. Extension Homemaker volunteer were trained to disseminate information to caregivers on communications skills, stress reduction, personal care, transfer and lifting, health care consumerism, and community resources. Most caregivers reported that the volunteers helped not only by providing information but also as a result of the socio-emotional support given to them (Halpert, 1988).

County extension agents and Extension Homemakers have a long and successful history of conducting community projects. The RTC: Rural proposed a challenging project for them which required an intensive level of community involvement for Extension Homemakers: engage Extension Homemakers volunteer to serve as the community-based link" between people with disabilities and information resources on assistive technology. The MSU Extension Service extended an invitation to the RTC: Rural to outline the project concept to attendees of the six Extension Homemaker District Meetings. The Objective was to determine if sufficient interest existed among the Homemakers to initiate such a project in any of their districts. Building on the Homemakers' support, a unique partnership was formed involving the RTC: Rural, MSU Extension Service, and the Montana Extension Homemakers, and a pilot project entitled The RANGE EXCHANGE was implemented.

The RANGE EXCHANGE

The RANGE EXCHANGE community-based outreach program was developed in response to the recognition that people with disabilities who live in rural areas are isolated from information on assistive technology and rehabilitation resources. In delivering rehabilitation services, the dissemination of information is critical. In the rural regions of Montana, rehabilitation professionals cannot properly meet the needs of the entire population and people are generally not equipped to obtain the necessary information on their own. The RANGE EXCHANGE offered a new approach to providing information on rehabilitation services and assistive technology for rural consumers.

Pilot Test of The RANGE

EXCHANGE

Seven Extension Homemaker volunteers were selected by county agents to serve as the community-based link" between people with disabilities and information resources. It was not necessary for volunteers to have a background in rehabilitation for this project. Because the Extension Homemakers were familiar with their communities, they were able to identify people with physical restrictions in their areas. The home visits provided the opportunity to gather information about the types of assistive technology being used, how well they worked and any do-it-yourself solutions these consumers had designed. The pilot project was conducted from March through June 1990 in a five-county area of Eastern Montana (Custer, Prairie, Dawson, Rosebud, and Treasure countries). The center of the pilot area is located approximately 300 miles from the project office on the MSU campus. Population densities of RANGE EXCHANGE field test countries are given in Table 1.
Table 1. Population densities of
RANGE EXCHANGE
field test countries.
 Area
County Population (sq. miles) Density
Custer 13,109 3,776 3.47
Dawson 11,805 2,374 4.97
Rosebud 9,899 5,019 1.97
Prairie 1,836 1,732 1.06
Treasure 981 975 1.01
Total 37,630 13,876 2.71


Training of Volunteers

Prior to conducting home visits, each Extension Homemaker volunteer attended a 1 1/2 day training program to conduct home visits to people with disabilities, to share information on adaptive devices and to help educate the consumer in using appropriate catalogs and publications are resources for direct purchase, modification or cost-effective fabrication of adaptive equipment. A practice in-home visit was included. The training also provided background information on disabilities and their consequences, assistive technology and how it is used and how to locate appropriate information and information sources on assistive technolgy. The volunteers were not expected to become experts on rehabilitation but to become aware of assistive-technology and its applications.

In addition, the training session included a sensitivity workshop. Participants simulated different disabilities and then had the opportunity to use various adaptive devices to perform different tasks. These exercises illustrated to the volunteers the relative difficulty of various tasks and the benefits of proper assistive technology in performing tasks. This session provided a comfortable introduction to assistive technology.

The training staff included RTC: Rural personnel and rehabilitation professionals from Montana VR, Montana Independent Living Center, community Rehabilitation Hospital, and the FaRM rural rehabilitation program in Iowa. Each presenter helped construct a through overview of rehabilitation and the goal of The RANGE EXCHANGE.

The Home Visit

Because of their community with the community, the Extension Homemakers were able to identify people with disabilities in their area. Working in pairs, they conducted "home visits" with people with disabilities in the test area. The Extension Homemakers become information providers by displaying various publications and catalogs illustrating adaptive equipment. The rural consumer is asked to identify essential problem tasks which are most critical for them to perform independently - inability to button shirts, for example. They are then asked what, if any, adaptive device they are currently using to assist them this task and how helpful the device is. If the respondent is interested, the volunteer can show then a catalog which describes products and/or options for the task. Difficulty manipulating buttons might be resolved by a button hook or by using snaps or velcro closures. By demonstrating how to locate a particular product in a catalog and determine its appropriateness, the volunteer helps the consumer take the first step towards findings solutions: identifying a specific device and learning how to find others.

Since consumers are experts on the devices they are using, the home visit also provides the volunteer an opportunity to gather information about how well those devices work in a rural environmental and what modifications or do-it-yourself designs have proven useful. When possible, photos or sketches of these do-it-yourself devices or modifications are made to subsequently be compiled and made available to others.

Identification of Consumers

Identifying consumers for home visits proven to be more demanding than anticipated. A substantial portion of the Extension Homemaker volunteer's time for the project was spent on this most critical activity. Different approaches worked better for different volunteers. Each volunteer in The RANGE EXCHANGE had an individual level of resourcefulness for recruiting respondents. An especially successful strategy for obtaining respondents was to mail an informal letter on an official letter-head from the county agent to potential respondents to introduce the project and its volunteers. Return postcards were sent with the letter. More than 50 percent of the postcards were returned requesting a home visit. The RTC: Rural also produced a promotional poster designed to recruit potential home visit participants. These RANGE EXCHANGE posters were displayed through the pilot region in cafes, barber shops, post offices, and other locations. The poster described the services The RANGE EXCHANGE could provide and encouraged people with disabilities to call their county agent for more information.

Operational Realities

The logistics of conducting a pilot project 300 miles away from the project office - even though in Montana this is only a Sunday afternoon drive - made it difficult for the RTC: Rural organizers to maintain a person-to-person intimacy with daily activities of the volunteers. Regular phone calls and letters are not an adequate substitute for personal contact. Preliminary planning sessions for The RANGE EXCHANGE had established three criteria for the selection of the pilot region: willing volunteers in the region, adequate number of people with disabilities in rural areas, and zealous county agents as coordinators. Of these criteria the enthusiastic support of the county agents was most critical.

An interim meeting held 2 months after the training session helped dissolve volunteer anxieties and provided an opportunity to explore successful home visit strategies. Anecdotal commentaries expressed by the volunteers enabled us to examine and evaluate the project as it evolved. A critical observation was made that to be scientific in our approach it was important for the volunteers to follow similar procedures in conducting the home visits. Individual interviewing techniques, teamwork, and establishing a commonality with the respondent were critical factors affecting the flow of the home visit. Some respondents were articulate in identifying their problem tasks, and the volunteers felt richly rewarded performing an information-sharing service.

Several critical elements must be considered when evaluating a pilot project such as The RANGE EXCHANGE. Some of these issues include: How acceptable are the procedures? How significant is the impact? How important is the goal? How does a person compare before and after? In order to gather this evaluation data from the respondents, a followup phone questionnaire was conducted at a reasonable interval following the home visit. The interval varied from as little as 1 month to as much as 5 months. The primary purpose of the phone survey was to determine whether the home visit actually benefitted the respondent. This was accomplished by asking 23 questions - some requiring yes/no responses and some open-ended questions.

Results

A total of 30 home visits with individuals and several group visits at various community locations were conducted by the volunteers. Ages of respondents ranged from 9 to 85 years (5 respondents did not indicate age), and 50 percent of the respondents were 60 or more years old. Results of The RANGE EXCHANGE home visits can be divided into two sections:

* Information collected from the consumers on the assistive technology they are currently using; and

* Utility of a home visit setting in facilitating access to information on assistive technology and rehabilitation resources.

Table 2 lists 32 disabilities identified by respondents in the study area. Several people identified more than one disability.
Table 2. Disabilities of people
 served by the RANGE
 EXCHANGE in the five-county
 pilot area.
Multiple Sclerosis 5
Stroke 3
Diabetes 3
Back Problems 3
Knee Replacements 2
Hip Replacements 2
Lower Extremity Amputations 2
Arthritis 2
Other Lower Extremity Mobility 2
Hand Fungus 1
Joseph's Disease 1
Other Upper Extremity Mobility 1
Vision Impairment 1
Ulcerated Sores on Feet 1
Post Polio 1
High Blood Pressure 1
Head Injury 1


Respondents reported a total of 121 personal care problem tasks, including bathing and toileting, grooming and hygiene, dressing and clothing, eating and drinking, reaching, carrying and holding, and transferring. On average, more than four problem tasks were reported per respondent. Table 3 summarizes the problem tasks that were identified by level of importance.
Table 3. Problem tasks identified
 by respondents by level
 of importance.
Task Identification Number
Bathing/Toileting: 20
Grooming/Hygiene: 14
Dressing/Clothing: 21
Eating/Drinking: 10
Reaching: 17
Carrying/Holding: 18
Transferring: 18


Considerable information on the use of assistive technology for personal care was gathered. Adaptive devices that were being used (more than 80 total) were obtained from commercial sources, were do-it-yourself designs, or were learned of through nontraditional channels. A tabulation of the most commonly used devices is presented in Table 4. Source of the device (commercial or do-it-yourself) and numbers being used by the respondents are included.
Table 4. Most commonly used adaptive devices and source.
Commercial Design Do-It-Yourself Design
bath bench/shower stool 8 support arms on chairs 2
grab bars 6 stair railings 2
walker 5 wheelchair tray 2
cane 3 bathmat 2
crutches 3 horse mounting steps 2
reacher 3 cart on rollers 1
raised toilet seat 3 slip-on shoes 1
card shuffler 2 seat across crutches 1
stocking aid 2 walker pocket 1
buttonhook 1 heel cushion 1
back scrubber brush 1 wire hook for reaching 1
bathtub seat float 1 pulley for raising arm 1
entry ramp 1 straps on shoes 1
lift chair 1 card holder 1
cup with lid and hold 1 built-up step 1
Amigo with high seat 1 clamps for craft board 1
bread slicer 1 magnetic holder for tool 1
potato peeler 1 worktable 1
egg separator 1 stylus holder 1
oversized tongs 1 lower telephone 1
wheelchair desk 1 adjustable height chair 1
large print magazines 1 crutch pocket 1
magnifying glass 1 lowered cupboards 1


The visits confirmed the notion that most respondents had very little or no familiarity with even the most common adaptive device catalogs and publications for activities of daily living. During the home visit the volunteer shared a variety of information resources for the consumer. Each consumer was given a handout packet containing several activity of daily living equipment catalogs, a resource directory for local rehabilitation professionals and service providers, assistive technology database access information, and information on disability-related consumer publications. The consumer browsed through these resources during the visit and was able to ask the volunteer for assistance or clarification. Several respondents expressed amazement not only at the amount of information available on adaptive devices but also at how specialized many devices are.

While looking through the equipment catalogs, respondents often indicated that "I could really use that..." The results of the followup phone survey conducted within a few months after the home visits indicated that two persons had purchased five pieces of adaptive equipment since the home visit, and three others had given it some thought. One respondent had contacted equipment manufacturers for additional product information. Not all of the respondents had the same degree of need for the information that was provided during the home visit, but they all indicated that "it's great to know that when I do need anything, I already know where to go."

Discussion

The volunteer component is an especially noteworthy feature of The RANGE EXCHANGE program. Volunteers are valuable because they are knowledgeable about local populations and their needs, tend to have high energy levels and strong commitments to their mission, and have a history of producing desired results. Volunteers can contribute in a variety of capacities based on their skill levels and available time and are a practical alternative to professional service providers in rural environments where services and information channels are limited. The RANGE EXCHANGE volunteers' abilities to encourage respondents to openly discuss assistive technology needs to resulted in greater information exchange and created a heightened volunteer self-esteem. One volunteer had an immediate family member with a disability and her ability to relate her personal experiences gave her an advantage in conducting home visits. She was able to establish instant rapport with an honest expression of her experiences: "I can remember having to go through this when Bob was injured."

It was emphasized to the volunteers that gathering information from respondents was as much a part of the project as sharing information. The volunteers were genuinely impressed with the respondents' creativity. Volunteers experienced satisfaction from receiving this information while the respondents experienced satisfaction in being "experts" and in sharing their valuable information. The do-it-yourself solutions to problem tasks were not necessarily sophisticated, but they were functional. Some were as simple as hanging a bucket on a crutch for carrying items, or using or dismounting from a horse.

The greatest amount of information gathered was in the era of personal care (bathing, eating, dressing, reaching, etc.). Personal care was the first category of assistive technology discussed with the respondents. Responses tapered off dramatically when questions concerned other functional area. Several explanation for this have been suggested:

* This line of inquiry may have consumed too much time in the interview schedule.

* Personal care could be the area of greatest need.

* Discussing personal care was most comfortable for the respondent or for the volunteer.

Some volunteers expressed concern that they might not be visiting the "right people." Instead of highly visible disabilities, such as spinal cord injuries or bilateral amputations, they were encountering people with arthritis or mobility problems due to hip replacements. The question was also raised whether visiting people who lived in Miles City, Montana, was rural enough!

More intensive pre-project publicity via newspaper articles, awareness presentations, and posters in the pilot area before project implementation would have improved The RANGE EXCHANGE visibility and, perhaps, credibility. It is possible that more people would have requested home visits if the project were more familiar to them.

Visits with residents of rest homes presented a dilemma. Group presentation to rest home residents seemed less intimidating on the surface, but residents appeared reluctant to make subsequent contact with the volunteers. Rest home residents must be able to take care of themselves. Contacting a volunteer for information on assistive technology could possibly be interpreted by rest home administrators, insurance provides, family, and others that the resident was unable to live independently. Another obstacle to recruiting consumers was their sense that they "were not crippled," "could get by on their own," and "don't need help."

One issue surfaced repeatedly: how to obtain funding for assistive technology. A common volunteer frustration after showing various items in catalogs was listening to the respondent confirm how helpful that device would be and then learning that the person was unable to pay for the item. When a respondent would indicate that "unless my insurance is going to pay for it...," some volunteers initially viewed information-sharing services as not fully resolving the problem. One volunteer's unique solution was to make a list of the desired devices and then ask if she could pass the list along to the respondent's relatives so they could then buy these for her birthday or Mother's Day etc. Is the real issue the financial inability to purchase assistive technology or simply stubbornness which boasts "I don't need help," "I can do without," or "I'm not going to pay good money for that." What should be emphasized here is that funding is a critical and unresolved issue.

Several respondents stated that they didn't need information on assistive technology at this time, but felt that exposure to the information was valuable because they knew where to go for this information. They realized that a time would come when they might need assistive technology, but they were strong in their conviction that they would not give in until that time. One 72-year-old respondent commented that it was getting difficult to arise from a chair or from the garage floor when he was working under his truck, but he nevertheless knew how good it was for him to do it on his own. He felt that he might be needing some help in the future, however, perhaps when he was 80 or so years old.

Only one respondent indicated the need for a potential second visit (and perhaps more for social than information reasons); however, several commented that an improvement for the program would be a followup of some sort, either another visit or a phone call. It is possible that just the act of visiting was a significant event; the respondents were generally impressed that someone out there cared.

The respondents strongly supported the format of the home visit. When asked if the information could be conveyed in a more effective way, they generally agreed that nothing compared to the one-on-one personal approach. One person indicated that he knew we meant well with our forms and surveys, but "you can't tell your troubles to a questionnaire, as you can to a person." Several people commented that when the public meetings are scheduled, you always have good intentions of going but people just don't show up. Literature mailed does not get read, whereas when delivered in person the volunteers were able to explain the materials. One person added that the visit provided the volunteer an insight into the home environment.

Respondents were very impressed by the volunteers, who were reported to be well-informed, friendly, caring, jolly and concerned. They shared the information, didn't push things off on people, presented different ideas, and discussed options. The home visit may have been a welcome social call for some respondents, but if improving morale is considered a desirable impact, the home visits were successful.

Conclusions

Have we succeeded in empowering the consumer by providing information on adaptive devices? Respondents beam when volunteers can supply them with valuable information. Actually obtaining and using assistive technology, however, requires additional consumer initiative and represents another phase of the empowerment process. One volunteer commented that many people wanted much more than just a link to information - they wanted someone to say, "Here's what you need. I'll take care of it, will be here Tuesday and it won't cost you anything!"

An unexpected outcome resulted from the home visits and contacts made during The RANGE EXCHANGE; the volunteers are experiencing a new level of understanding and awareness on disabilities and rehabilitation - an empowerment that gives meaning to what they have done.

As the 21st century approaches, the Cooperative Extension and the land-grant university system of which it is a key part are at a crossroads. The Cooperative Extension came into existence as a creative attempt to help people solve problems. Recently, many formerly supportive clientele have criticized the Cooperative Extension for becoming unresponsive and irrelevant and for failing to change and adapt to a rapidly changing world (Brown, 1989). Some segments of the public want more consumer-related activities in such areas as energy conservation and human nutrition and youth, consumer, and community development. Extension directors, on the other hand, are re-emphasizing production agriculture (Warner and Christenson, 1984). In April 1991, the Extension Service initiated a major program in rehabilitation technology to provide education and onsite technical assistance to farmers with disabilities and their families. This new emphasis unites the efforts of the Extension Service and non-profit disability organizations and incorporates significant participation by volunteer groups in providing technical information and rehabilitation service delivery. The pooling of rehabilitation and agricultural community resources at the local level reaffirms the 1914 Extension Service mandate to provide education for the purpose of assisting people in making their own decisions. Improving the lives and enhancing the independence of people with disabilities who live in rural areas can have a profound impact on preserving the integrity of the rural community.

The RANGE EXCHANGE may not be the final solution to information dissemination on assistive technology in rural Montana, but it is a beginning. Given the right motivation and continuous support volunteers are unstoppable. And in a state like Montana, where public funds are as plentiful as the albatross, volunteers can and do provide as much needed link between people and the information they seek.

Bibliography

[1.] Baker, S.P., O'Neill, B., & Karp, R.S. (1986). The injury fact book. Lexington, MA: D.C. Health and Company. [2.] Brown, N., (1989, Spring) Too little, too late?, Journal of Extension, 5. [3.] DeMarco, S. (1980). Country visits. In Evaluation of Economic and Social Consequences of Cooperative Extension Programs (Appendix I). Washington, DC: U.S. Department of Agriculture. [4.] Marrs, L. (1988). Community networking can facilitate independent living. Presented at Meeting the Rehabilitation Needs of Rural Americans, Missoula, MT. [5.] Mathesen, D.V. & Page, C.M. (1985). Prepared Testimony to the Oversight Hearing on the Rehabilitation Act by the 99th Congress. (Serial No. 99-85). Washington, DC: U.S. Government Printing Office. [6.] U.S. Department of Agriculture. (1990). Montana Agricultural Statistics, Volume XXVII. Helena, MT: National and Montana Agricultural Statistics Service. [7.] National Center for Health Statistics (1984). Health Characteristics by Geographic Region, Large Metropolitan Areas, and Other Places of Residence. Series 10, No. 146, Hyattsville, MD: U.S. Department of Health and Human Services.

[8.] Omohundro, J., Schneider, M.J., Marr, J.N., & Grannemann, B.D. (1983). A four county needs assessment of rural disabled people. Journal of Rehabilitation, 19-24. [9.] Popper, F.J. (1986). The Strange Case of the Contemporary American Frontier. Yale Review, 76 (1), 101-121. [10.] Reczynski, D.F., Tibbs, B.D., & Turk, L.F. (1987). Environmental Assessment for Rural Hospitals 1988. Chicago, IL: American Hospital Association. [11.] Richards, L., Frieden, L., Gerken, L., & Veerkamp, E. (1984). Independent living in rural America. In Proceedings of the International Conference on Rural Rehabilitation Technologies. Grand Forks, ND: University of North Dakota. [12.] Seekins, T., Jackson, K., & Dingman, S. (1991). Rural rehabilitation issues from the consumer's perspective. Missoula, MT: University of Montana, Research and Training Center on Rural Rehabilitation. [13.] Tonsing-Gonzalez, L., (1989) Rural independent living: Conquering the final frontier. Meeting the Rehabilitation Needs of Rural Americans. Papers from the First National Conference of the RTC: Rural. Missoula, MT. [14.] Warner, P.D. & Christenson, J.A. (1984) The Cooperative Extension Service: A National Assessment, Boulder, CO: Westview Press, p. 10.
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Title Annotation:Rural Rehabilitation
Author:Seekins, Thomas W.
Publication:American Rehabilitation
Date:Mar 22, 1992
Words:5383
Previous Article:Innovations in rural independent living.
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