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Work 48 (2014) 117–126 DOI 10.3233/WOR-141860 IOS Press

“Home is at work and work is at home”: Telework and individuals who use augmentative and alternative communication David McNaughtona,∗, Tracy Rackenspergerb, Dana Dorna and Natasha Wilsona a

Department of Counseling and Educational Psychology and Special Education, Pennsylvania State University, University Park, PA, USA b Institute on Human Development and Disability, University of Georgia, Athens, GA, USA

Received 18 November 2012 Accepted 25 November 2013

Abstract. BACKGROUND: Telework, the use of distance communication technologies to participate in the workforce, has been suggested as a promising employment strategy for individuals with disabilities. OBJECTIVE: The goal of this study was to obtain a better understanding of the benefits and negative impacts of telework, as well as the supports and challenges to telework activities, for persons who use augmentative and alternative communication (AAC). METHODS: This study used a series of focus group discussions, conducted on the internet, to examine the employment experiences of nine individuals with disabilities who used AAC and who held jobs that involved the use of telework. RESULTS: Four major themes emerged from the discussion: (a) benefits of telework, (b) negative impacts of telework, (c) strategies for addressing negative impacts of telework, and (d) recommendations for improving employment outcomes for individuals who use AAC. CONCLUSIONS: In summary, while participants identified the elimination of travel time and flexible work schedules as key strengths of telework, concerns were expressed regarding feelings of isolation and the difficulty in separating home and work environments. The participants also emphasized the important role of educational programs in supporting the acquisition of literacy and self-advocacy skills, and the need for post-secondary programs to support the school-to-workplace transition. Keywords: Employment, severe disability, cerebral palsy, autism, assistive technology

1. Introduction For individuals who have complex communication needs (CCN) and who experience difficulty in communicating with speech (e.g., individuals with cerebral palsy, autism, or traumatic brain injury), obtaining and maintaining employment can be a challenging process. ∗ Corresponding author: David McNaughton, 227 CEDAR Building, Department of Counseling and Educational Psychology and Special Education, Pennsylvania State University, University Park, PA 16802, USA. Tel.: +1 814 865 7159; E-mail: [email protected].

The use of augmentative and alternative communication (AAC) techniques such as speech-generating devices, communication boards, and sign can provide important supports for communication in workplace activities [1–3]. At present, however, only a small percentage of individuals who use AAC are employed, despite their efforts to participate in the workforce [4–6]. Individuals with CCN face many challenges in seeking employment, including inadequate educational preparation and attitudinal barriers [7–9]. For many individuals with CCN, however, the lack of appropriate work-site supports poses a significant barrier to partic-

c 2014 – IOS Press and the authors. All rights reserved 1051-9815/14/$27.50 

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ipation in the traditional workplace [10–12]. Individuals with CCN often have physical disabilities and require specialized transportation supports, which are often unavailable in rural areas and difficult to schedule in urban areas [13]. Many individuals with severe disabilities who use AAC also will require supports in the workplace for activities of daily living, such as mealtime and toileting routines [14]. Finally, individuals with complex communication needs may have a specialized skill set (e.g., knowledge of assistive technology devices, or disability policy issues) that may be desired by a particular employer who is at a considerable distance from the potential employee. In these situations, individuals with CCN may be reluctant to move to be closer to a job and to leave behind a network of local supports, including modified housing, family, and friends [15]. Telework has been described as a promising approach to providing needed supports for employment to individuals with disabilities [16]. Telework is an employment activity in which an individual works from home (or another non-office setting) and communicates with co-workers via distance communication technologies such as email or skype [17]. Because the individual works from home, the challenge of travelling back and forth from the office is reduced or eliminated. The individual is able to make use of personal care services and specialized work station adaptations available in their home [12], and does not need to leave community supports behind in order to move closer to a job site. While there are a number of positive features associated with telework, there are also concerns. For example, one of the benefits of employment is the opportunity to engage in social interaction with co-workers [5, 18], however employees who work in telework positions may experience social isolation [12]. In addition, many new projects arise from informal conversations in the workplace – telework employees may experience a lack of “presence” in the workforce, and not be considered for advancement opportunities [12]. Recent changes in the power and affordability of computer and telecommunication technology has resulted in increased attention to telework both for individuals with and without disabilities [3,19]. A recent meta-analysis of 46 studies provided evidence that telework appeared to have positive impacts on employee satisfaction and work performance [20]. Much of the research on telework has been conducted with individuals without disabilities, however, and there has been only limited research attention to the impact of

telework on key aspects of employment for persons with disabilities [21]. This study, therefore examined the telework experiences of nine individuals who use AAC. The goal was to obtain a better understanding of the benefits and negative impacts of telework, as well as the supports and challenges to telework activities for persons who use AAC.

2. Method 2.1. Design This study used a qualitative research design to gain an understanding of employee perceptions of the feasibility and outcomes of telework employment for employees who use AAC. Data from participants were collected using both questionnaires and an internet based focus group that was held over an eight-week period. The use of an asynchronous focus group methodology conducted on the Internet [6,22,23] allowed the participation of subjects from across the United States, at times convenient for the participants . 2.2. Participants 2.2.1. Criteria for participation Individuals who were selected met the following criteria: (a) they used AAC; (b) they had been successfully employed for at least six months; (c) they worked a minimum of 10 hours per week for a communitybased employer (excluding sheltered workshops); (d) they worked from home at least 10 hours per week (i.e., some individuals may also have worked at another location for some time each week); (e) they communicated with their office/employer using email, instant messaging, or the telephone; (f) they had access to the internet; and (g) they were able to commit 1-2 hours per week to the discussion for a 5-week period. 2.2.2. Recruitment of participants A research team member posted information describing the project to a listserv that serves the AAC community, and provided details of the study (e.g. explanation of methods, time commitment required, and information regarding confidentiality). In addition, individuals known to the researchers through prior collaboration, publication or visibility within the AAC community were contacted directly via email and asked to participate. Responses asking for more information were followed up with individual emails to

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clarify details, and materials on informed consent procedures. This research project was reviewed and approved by the Human Subjects Review Board at the first author’s institution, and all participants provided informed consent. Pseudonyms are used throughout the study for all participant comments in order to maintain confidentiality. 2.2.3. Description of participants Nine participants (six male, three female) took part in this study. All but one participant had a diagnosis of cerebral palsy – Jeff had a diagnosis of autism. The participants reported ages between 27 and 58, and their highest level of education ranged from several college credits to completion of a doctoral degree. The participants typically used a variety of modes to communicate, often using speech and their AAC system for clarification with familiar partners, and relying more extensively on their AAC systems for communication with unfamiliar partners. Four of the participants used a speech-generating device (SGD) that incorporated a MinspeakTM approach to vocabulary representation (e.g., Pathfinder PLUS); one of the participants used a device that incorporated a dynamic display (“paging”) approach to vocabulary retrieval (e.g., Dynavox DV4); and three used highly portable text-to-speech devices that provided a small keyboard and display (e.g., Lightwriter). One participant made use of handwriting when her speech was not understood. 2.3. Materials The discussion was hosted on an internet-based discussion board system. Participants and the moderator could access and post to current and previous topics via links on a password-protected index page. The questions were developed based on a review of the research on telework and the employment of individuals who use AAC, and were reviewed and modified by the moderator, who is herself a person with CCN who uses AAC. The moderator then posted the questions to the online focus group. The use of a message board style of online communication eliminated the need for participants to be available in the same location and at a specific time of day, as would be necessary in order to take part in a traditional focus group.

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naire via e-mail asking for demographic information. A “Welcome” thread was started by the forum moderator to allow participants to introduce themselves and to practice posting to the forum. The moderator started a new thread after the previous topic had been discussed, approximately every 3 to 5 days over a period of 2 months for a total of 14 threads. Each thread addressed specific questions about employment and telework. The moderator facilitated discussion by asking participants to introduce themselves, and by asking specific Telework- and AAC-related questions. Follow-up questions were posed, as necessary, in an effort to encourage full participation (e.g., “Can you tell me more about. . . ?”, “Has anyone else had a similar experience?”). 2.5. Data analysis The data (i.e., focus group discussions) were first divided into units following Guba and Lincoln’s (1985) definition of a unit as “the smallest piece of information about something that can stand by itself . . . interpretable in the absence of any additional information other than a broad understanding of the context in which the inquiry is carried out” [24, p. 345]. The first author reviewed the unitized datum to examine similar themes among the nine participants [25]. Open coding was used, and words or phrases were assigned with the goal of capturing the meaning of lines or phrases in the transcripts [25,26]. After developing an initial set of codes, as well as operational definitions, the first and third authors each independently coded a portion of the unitized datum. The final identification of themes and operational definitions was reached through consensus [27] and all of the data were coded. Discrepancies in coding were resolved by discussion among team members. Based on this interpretive thematic analysis, the first author prepared a written summary of the major findings of the focus group. Each participant was sent a copy of the written summary of the findings, and was asked to provide feedback via email. All nine participants verified that the summary of the content themes reflected the discussion in the group.

3. Results 2.4. Procedures Once participants had completed the informed consent forms, they received and returned a question-

The results of the study are discussed in this section, including the description of employment activities provided by the participants, and the content ad-

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dressed under the four major coding themes: (a) benefits of telework, (b) negative impacts of telework, (c) strategies for addressing negative impacts of telework, and (d) recommendation for increasing employment opportunities (including telework) for individuals who use AAC. 3.1. Description of employment activities All participants worked in jobs that involved the use of computers to communicate with others (see Table 1: Employment activities). Three participants (Farrah, Jeremy, Sharon) worked on disability related issues (e.g., writing on topics related to disability) for the government, an advocacy organization, or a government funded research project. Three participants (Jeff, Scott, Sebastian) worked on non-disability related issues (e.g., administering a database) for government organizations. Two participants (Fred and Jamal) provided educational support and technical input (e.g., developing presentations, providing suggestions for research and development) to AAC manufacturers; and one (Reba) taught for a university. All but two individuals (Reba and Jeff) received paid Personal Care Attendant services in their home as they participated in telework activities. 3.2. Benefits of telework The analysis of the participant comments resulted in the identification of three major benefits to telework: (a) increased work efficiency, (b) flexible scheduling, and (c) easier communication with co-workers. 3.2.1. Efficiency Many of the participants described the positive impact of telework on their work efficiency. The elimination of travel time (including both time in transit as well as waiting for specialized transportation services) made many more hours available in the day for employment activities. Scott commented, “My trip to the office is cut from an hour and half to thirty seconds.” In addition, the ability to have predictable access to adapted computer systems at home increased the likelihood that needed technology adaptations would be available. As Sharon commented, “I have my own equipment set up and I don’t have to transport it back and forth to and from work.” 3.2.2. Scheduling The benefit of being able to manage one’s own work schedule was frequently noted by study partici-

pants. Two important aspects of increased control over scheduling were noted. First, individuals could schedule their work in ways that allowed them to accommodate for their physical disability. Jeff (a young man with autism) wrote, “Due to my disability, I get worn out fairly easily with an in-office work day. Being at home is less exhausting.” Second, with control of their own work schedule, teleworkers were better able to manage medical appointments, shopping, and other activities of daily living. 3.2.3. Communication with co-workers The use of telework introduces changes to the traditional patterns of communication in an office. For many of the participants, the communications strategies associated with telework (e.g. e-mail, instant messaging) were often the preferred communication techniques of the person with CCN. As Jeff described, “(The use of telework) forces others to think through their questions that they ask me, and allows me to write back a written response rather than a verbal one.” 3.3. Negative impacts of telework Although all of the participants reported that telework had many benefits, they also discussed the negative impacts associated with telework. Three subthemes related to negative impacts were identified: feelings of isolation, technical and equipment problems, and the difficulty in separating home and work environments. 3.3.1. Feelings of isolation Many of the participants described their concern that working from home and reliance upon distance communication technologies impacted the development of both work and social relationships. As Faith wrote, “Working from home eliminates the relationships between co-workers . . . Communicating by phone or email loses the face to face interactions that many people need to establish trust.” Jamal supported this view, writing, “Face to face contact with colleagues is extremely important. . . In receiving emails, I often wish that I could hear the sender’s tone of voice. It is sometimes intimidating to not have this option.” The use of telework also impacted the spontaneous informal communication opportunities that can occur in traditional work-places. As Jeremy wrote, “I live 200 km from the office – I can’t say to my co-worker ‘tonight, let’s go get a beer’ . . . ”.

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Table 1 Employment characteristics of the participants Participant Farrah Fred Jeremy

Diagnosis CP CP, learning disability CP

Age 28 27 35

Jamal

CP

58

Jeff

Autism

27

Reba Scott Sharon Sebastian

CP CP CP CP

35 32 23 36

Job duties Health care advocacy, aid transfer to independent living Remote technical support for AAC manufacturer and distributor Writing, research/monitoring on policies related to people with disabilities Present at national and state conferences, support research and development activities for assistive technology company Database administration/programming. Primarily web applications Online teaching as an assistant professor at a university Development and maintenance of electronic technical manuals Writing skills coaching for adults with disabilities Data entry and database maintenance

Some teleworkers wrote that they believed there was less feedback from supervisors because of the telework structure. Participants frequently discussed what they perceived as the limited feedback and recognition from their employers. One participant commented “I could go days without receiving an e-mail of recognition from my employer. I need regular live discipline, be it positive or negative.” 3.3.2. Problems with home technology One participant provided information on the technology and equipment challenges of working from home. For this individual, the slow connection speed of his home internet provider reduced his productivity. In addition, this individual reported that he felt that he needed to purchase his own desk, chair, and printer, noting “I didn’t want to risk that I would be told ‘Well, if you need all this stuff, why don’t you just work here where we already have it all?”’. 3.3.3. Difficulty in separating the home and work environment Some of the participants described the challenge of separating the home and work environment. Sharon commented on the difficulty of remaining focused while working at home without co-workers or supervisors, writing, “There is no one to call me back from the breaks – sometimes I don’t return to work after getting a drink to quench my thirst.” While working independently from home provided access to specialized computer technology and workstations, it also gave easy access to non-work and recreational activities. Participants described the challenge of maintaining a focus on work activities while surrounded by the “temptations” of home. As Sebastian wrote “ With telecommuting there are distractions from doing the work, like surfing the Internet, chatting online, taking care of personal business. . . it’s a chal-

Telework hours per week 10 25 25 35 20 25 40 16 20

lenge to keep plugging along and enter the data. The work is very dry and boring. So it’s very difficult to stay on track.” In addition, family members and personal care attendants often had difficulty treating the home as a “work” environment. Jeff described the challenges of getting family members to acknowledge the use of the home as an office, writing “I think it is especially important that everyone around the teleworker treat what they are doing the same way they would treat someone going to an office building downtown . . . it is not a time to interrupt with anything but true emergencies”. Sharon wrote “Working from home also makes an abstract situation for my PCAs [Personal Care Assistants]. . . The staff is not prepared to assist me with what I need to work.” Not only did home temptations interfere with work, but reminders of work interfered with non-work time. Sharon wrote “My working space and living space totally overlap and constantly interfere with each other. . . I can’t look forward to getting off work and going home. . . I am reminded of my work evenings, weekends, and holidays because it stays there in my bedroom . . . Home is at work, and work is at home.” 3.4. Addressing the negative impact of telework Participants discussed a number of ways to address the negative impacts of telework, and made recommendations for the employee and employer, as well as educators and rehabilitation service providers. 3.4.1. Reducing feelings of isolation The participants had three suggestions for dealing with feelings of isolation. First, participants spoke of the importance of actively building work and social networks. One individual (Jeff) described initiating the development of a work “network” by asking a co-

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worker to help as his “eyes and hands” at the main office when he could not be there. Participants encouraged the employer to take a leadership role in building these networks by “extend[ing] invitations to office parties, business trips, informal gatherings to the teleworker” (Sharon). Some employees went to extraordinary lengths to be socially involved in the office – one individual took a 6-hour bus ride to attend the office Christmas party! Second, the participants suggested that employers should take an active role in developing a wide variety of communication opportunities for the individual who uses AAC. The employer should collaborate with the individual who uses AAC to ensure that all employees understand the role of the individual who uses AAC, and the many ways in which they communicate. Everyone in the work environment should be made aware that communication should “not be limited to email” (Sharon), but should include other techniques such as conference calls, chat rooms, and Instant Messaging (Fred). Especially important was the scheduling of meetings to insure that some “face-toface” contact occurred on a regular basis. While this was often challenging, a number of participants said that their employer was receptive to creating schedules so that meetings could be “chunked” on days when the employee was able to travel to the office. The third major suggestion was that the employer should address not only the quantity of communication opportunities, but also the quality of communication interaction – the employer should serve as a model of appropriate communication by “being patient and giving us time to speak spontaneously” (Sharon) and to be sure that everyone is “on the same page” before moving on to a new topic (Jamal). When the teleworker could not be present in the workplace, it was important that the employer continue to act as a role model. As Jeff wrote: (The employer) needs to ensure the employee is talked about in a professional manner even when the employee isn’t there. . . [The employer] needs to correct misunderstandings and resentments other employees may have towards the telecommuter. . . and justify the telecommuting option to upper management. As another way to help the employee feel like a true member of the organization, participants also described their sincere interest in regular honest feedback on their performance with the current job, and their opportunities for advancement. Jeff wrote: “The boss needs to communicate to the telecommuter how their performance will be measured and give frequent feed-

back. . . If he (a boss) is unhappy about something, he needs to say so and explain why. If he is happy, likewise, he should say something”. 3.4.2. Obtaining needed equipment Participants described the importance of clearly communicating their technology needs to others, and to be ready to problem-solve with company technology consultants to obtain desired outcomes. For example, Jeff reported, “My house does not have the security systems that my normal workplace has, so we did what the security guys suggested to keep things from getting physically stolen”. They also reported that employers should be ready to help obtained needed equipment, but should also plan to deal with breakdowns. As Jeff wrote, “They (employers) should make sure they have a plan to handle equipment breaking so that a computer breaking at my home does not put me out of work permanently or even temporarily.” Participants described the need to advocate for themselves; as Jeff wrote, “ I’d recommend each person asking their employer for as much as they are likely to get without compromising the entire telecommuting proposition.” At the same time, the participants recognized the importance of being prepared to compromise. As Fred wrote, “If you have to start expecting everything, you’re not only jeopardizing your job and your employer’s interests in having you work for them, but most importantly I feel you would be also jeopardizing your name, because nobody wants and enjoys working with a very demanding person.” Participants spoke of the need to keep the long term goal of a positive working relationship in mind when making decisions about when to advocate and when to compromise. Jeff wrote, “For telephone, [I] simply purchased a flat rate long distance plan. But while I ’should’ get reimbursed, the $3 or $4 per month that would be work’s share just isn’t worth the effort.” Ultimately most participants reported that they have successfully obtained needed accommodations. As Fred stated, “I myself have gotten very much reasonable accommodations from my employer. . . I haven’t expected cake, ice cream and whipping cream, I have expected just cake.” 3.4.3. Creating a positive work environment at home Participants had recommendations for both employees and employers for creating a positive work environment at home. For the employee, they spoke of the importance of setting a work schedule and “living up to it” (Jamal). Farrah recommended creating a profes-

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sional environment, including getting dressed, taking timed breaks, etc. One individual even placed pictures of his fellow employees around his work station in order to create a more work-like environment! Participants had a number of recommendations for making a clear delineation between home and work. Sharon recommended that telework employees should, “Try to set aside space in the home and convert it into a private office away from distractions or household responsibilities.” Jamal suggested that posting a public schedule would not only let personal care attendants know when work was taking place, but also provide “a means for the teleworker to know when to quit for the day.” The participants spoke to the social strain of telework on both themselves and family members. Jamal wrote, “If you have a spouse, be sure to quit on time and make the partner special.” With respect to the reduced direct supervision that is associated with telework, the participants described regular meetings and the clear communication of respect by the employer as critical to a productive work experience. Reba wrote, “Trusting teleworker’s ability (responsibility) is one of the most important virtues that employers should have.” Clearly, it is a delicate balance. While workers acknowledged the challenge of working without the usual workplace reminders, they also reported that they did their best work when, as Jeff wrote, “the employer ‘lets’ the worker be self-directed. Micromanaging works even less well when there is telecommuting involved.” The regular exchange of ideas and feedback made an important contribution to the maintenance of productivity. Fred wrote that he did his best work because, “I feel like I’m totally included among a group of people, they respect my feelings and most importantly they know I have a lot of knowledge and ideas to share with them and several others.”

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cially with email becoming one of the major forms of business communication. There is no way I could do my job without good reading and writing skills.” 3.5.2. Transition programming While school played a key role in providing formal academic skills, many participants spoke with their frustration with the lack of transition programming and preparation for the workplace. Sharon wrote, “My academic experience did not transfer. I can write a smashing 15 page paper on Edmund Burke, but I didn’t know how to write an effective business letter or make a budget. I felt disorganized (when I started work).” Participants were especially interested in summer or after school work placements while in high school, and in meeting role models – individuals who used AAC and were employed. Jeff wrote, “I would have loved to see someone using AAC at work . . . heck, I would love to see someone else using AAC at work now.” Jeremy thought that the opportunity to meet with someone with CCN who was successfully employed could have a powerful impact, noting, “These students will see other persons older than them be active on the job market and it will sow something in them.” 3.5.3. Self-advocacy Finally, participants discussed the importance of developing self-advocacy skills. As Sebastian wrote, “I have learned you have to do things yourself and stay on top of people who are supposed to help you.” Jeremy discussed his belief that these skills of selfdetermination and self-reliance were best developed over time, writing “I think that the road to work begins at an early age, and that schools have a lot of responsibilities. It’s part of the families/school/work continuum that take place throughout life.”

3.5. Increasing employment opportunities 4. Discussion The participants identified three major issues that they believed had contributed to their success with telework, or that if provided, would have been beneficial: strong literacy skills, transition programs (including work placements) while in high school, and strong selfadvocacy skills. 3.5.1. Literacy For all of the participants, the ability to read and write played a key role in their employment success. Jeff wrote, “Definitely literacy is a key issue. We need to know how to read and write to succeed today, espe-

As has been reported in other investigations of telework for persons with disabilities [12,16,28–31], the individuals who use AAC that participated in this study described a range of benefits and challenges associated with telework. Persons who use AAC reported that this approach to employment had many of the same benefits as reported in research with both non-disabled and disabled individuals. As in other research examining the telework experiences of workers with disabilities [30] the reduction or elimination of time spent dealing with transportation issues (and the resulting in-

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crease in efficiency) was a major benefit for the teleworkers in this study. This may be an especially important factor for all individuals with disabilities [32, 33] and not just those who use AAC, as these persons also are often reliant upon specialized transportation arrangements with limited scheduling options. Participants also enjoyed the ability to have greater control of their schedule. While past telework research has typically investigated issues associated with balancing work and family duties for individuals without disabilities [34], for the participants in this study, control of their work schedule enabled them to work in ways that accommodated their need to schedule attendant care services and medical appointments. Finally, past research has documented the communication challenges associated with telework for many individuals with disabilities, and not just for those who use AAC [16]. It is of interest to note that, for many of the participants, the use of telework actually provided support for their preferred methods of business related communication, including the use of asynchronous techniques such as email. For individuals who use AAC, face-to-face interaction in the workplace, with its emphasis on rapid communication using a wide variety of vocabulary items, is a challenging process [11,35]. The use of the methods of communication typically used in telework, which allow individuals with CCN to prepare, review, and then send a message, actually were seen as an advantage, and not a drawback, by many. The participants in this study also identified some of the same drawbacks to telework as have been reported elsewhere, especially with respect to social isolation. The participants in this study expressed concern about the difficulties in developing trust with their employer [29,36,37], especially when face-to-face contact was limited [36]. This is a challenging topic, because individuals who use AAC also report having to deal with negative attitudes in the traditional workplace [23,35] so it cannot be assumed that any difficulties are necessarily associated with telework. Still, the potential that teleworkers will be “out of sight, and out of mind” [38] may be exacerbated for individuals with disabilities [16]. Proposed methods for addressing feelings of isolation focused on the importance of the relationship between the teleworker and their supervisor, and the believe that the supervisor should act as a “model” for the other employees with regard to communication and social interaction [39]. While this type of positive supervisor-employee relationship for people who use AAC has been observed in some tra-

ditional workplaces [11], we have only limited information as to how this might be achieved in a telework environment. As in other telework research with persons with disabilities [16,40] participants identified difficulty in obtaining and using needed equipment. As is common in the telework literature, there was substantial confusion about the responsibilities of the employee, and the employer [39] and the legal issues associated with equipping a home office [41]. In addition, many of the participants described their difficulty in separating their home and work environments. Telework often blurs the boundary between work and private life [42,43], placing stress not only on the teleworker, but on those around them, who may be confused as to expected roles and activities [44]. The issue of maintaining a divide between work and home life is expected to be a challenge not only for individuals formally engaged in telework, but for many individuals, as new communication technologies support access to employment activities from a variety of locations [36,38]. Finally, obtaining and maintain employment is a challenging process for persons with complex communication needs, and a wide variety of strategies and supports are necessary to promote success [45– 47]. In this study, the participants emphasized the importance of educational preparation targeting literacy and self-advocacy skills, as well as appropriate postsecondary transition programs, to support employment success for persons who use AAC. Continued research is needed to identify strategies that will support persons with CCN in participating in desired adult roles such as employment. While proactive work is needed to address the potential drawbacks of social isolation, and the reported perception of a lack of boundaries between work and non-work activities, telework appears to be a promising approach to employment for individuals who use AAC. Telework can support workforce participation for individuals who otherwise may face significant barriers in participating in the traditional workplace. It is important, however, that telework is developed as a choice for individuals with CCN, and not presented as the only available option because of poor infrastructure support (e.g., deficient public transportation, inaccessible buildings). Continued research is needed to ensure that individuals engaged in telework enjoy the traditional benefits of employment, including not only the feeling of making a contribution to society, and being paid, but also opportunities for social interaction, and peer recognition for completed work.

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Acknowledgments This research was supported in part by the Communication Enhancement Rehabilitation Engineering Research Center (AAC-RERC), which is funded by the National Institute on Disability and Rehabilitation Research of the US Department of Education under grant number H133E980026. The opinions contained in this publication are those of the grantee and do not necessarily reflect those of the Department of Education.

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