By: Lilian Aluri, REV UP Intern and NYU Vote 2020 Fellow at AAPD

August 25, 2020

COVID-19 has pushed the world into a new digital era in which we are using the internet more than ever for connecting with family and friends, tracking the news, organizing for social justice, working from home, and fighting off boredom. Zoom is the new bar, classroom, and more. You name it, and we have found a way to move it online during the pandemic. A GALLUP poll indicated that nearly 7 out of every 10 employed adults in the U.S. were working at home at least part of the time this May, and many businesses expect that some remote working will continue even after the pandemic.

In this new digital life, it is more important than ever to consider how accessible or inaccessible the digital world is to the 61 million Americans with disabilities. In the U.S., 15% of adults have hearing loss or a hearing disability, while about 10% of adults have blindness or low vision. Another 3% have intellectual or developmental disabilities. Many of us know that accessibility is important, but perhaps don’t know where to start or think of it as “too much work.”

I’m here to say #1: digital accessibility is not only important, it is absolutely critical. Digital accessibility is about the shared human right to engage in the world we live in. #2: It’s not that difficult. Making digital information accessible takes work and requires planning ahead, but following digital accessibility is just another skill to learn. If we all can learn to navigate Zoom, we can learn how to provide captions for our events, and more.

Where to Start

Digital accessibility encompasses making virtual events, social media posts, websites, digitally shared documents, and more inclusive to people with a range of disabilities. Thankfully in 2020, we live in an era with endless resources for how to achieve digital accessibility. Below are some great resources from the disability community:

• American Council for the Blind: 5 Accessibility Actions You Can Take When You’re Moving Your Conference or Classes Online
• Office of Civil Rights: Webinar on Online Education and Website Accessibility
• National Deaf Foundation: Remember Accessibility in the Rush to Online Instruction: 10 Tips for Educators
• Multiple Resources Recommended by the Autistic Self Advocacy Network
• Multiple Resources Recommended by the American Council for the Blind

In this blog, we have put together some tips and definitions to get you started on making your digital communications accessible!

1. Social Media

Alternative Text

Alternative text (also called image descriptions) are word descriptions of what is in an image. Alternative text (alt text) and image descriptions allow people with blindness and low vision to experience images in addition to text when they are using a screen reader—an assistive technology that reads text on a computer or phone screen aloud.

While image descriptions should be used any time an image is included in digital communications, social media makes it easy to include image descriptions. Platforms like Twitter allow you to add alt text when making a post, and on Instagram and Facebook which allow for more characters, you can also add image descriptions at the end of the main text of the post. Some tips for making effective alt text include:

• Keep image descriptions to the length of a tweet (280 characters).
• Focus on what is important in the image and why it was included.
• Quote important text in the image word for word.

Readability

When writing, there are a few things you can do to ensure that your social media text is clear and readable:

• Put hashtags and links at the end when possible so that someone using a screen reader can read the social media post without being interrupted.

2. Videos and Virtual Gatherings

Captioning

Closed Captions (CC) are lines of text, often at the bottom of a video or TV screen, that not only provide a text transcription of any words said but also describe other sounds, such as background music. Closed captions help make the audio part of videos accessible to people who are hard of hearing or deaf. While platforms such as Youtube may have automatic captioning, you make sure your video captions are accurate by using a captioning service to provide captions for your videos. Live captioning for events (virtual or in person) is called CART, which stands for Communication Access Real-Time Translation (CART), and there are endless companies that provide captioning and CART services. Here are a few:

• Streamtext
• Alternative Communication Services
• PostCap Project.
• If you have the time, you can also caption a video yourself for free.

When coordinating captioning for videos and live virtual events, you can help captioners and speed up their work by sending them the names of all participants, the agenda, scripts for remarks from speakers, and the headshots of speakers. Captioners usually provide a text-only link to share with participants that can make the captions easier to read by allowing the reader to:

• View whole paragraphs of the transcript
• Control how fast they are reading the captions
• Remove the distraction of the video or visuals

In Zoom, meeting hosts can assign a captioner so that CART is available directly in the platform. Note that when using breakout rooms, you will have to coordinate multiple captioners to cover the multiple breakout rooms. The number one thing to remember is to START EARLY with all of your captioning and CART needs, and make sure you have all of your captioners hired and any videos pre-captioned at least 72 hours before the event. It takes time for captioning to be completed and reviewed for accuracy.

American Sign Language (ASL)

American Sign Language (ASL) is a language using hand and face movements that is used by about half a million people in North America, largely people who are deaf or hard of hearing. Learn more about ASL through the National Association of the Deaf. With such a large community of ASL speakers, there are countless ASL interpreters that you can hire to make your webinars and events inclusive. Here are just a few:

• ASL Interpreting Services
• Accessible Communications for the Deaf
• Vineya
• Globo
• Purple

Just as we recommended when working with captioners, providing information on speakers, scripts and statements, and any other event materials in advance helps ASL interpreters prepare for events! 

For smaller meetings and gatherings, whether or not you need ASL will depend on your audience. But when hosting events open to the public, including ASL is key to ensuring everyone can engage in your event. Remember, ASL is its own language! Providing only captions to an ASL-speaker is like providing only English captions to a Spanish-speaker. When incorporating music (beyond background music), there are lots of ASL interpreter groups skilled in interpreting music, including DEAFinitely Dope and Amber G. Productions.

Incorporating ASL interpreters into Zoom and other virtual meeting platforms is easy! In Zoom, encouraging participants to use the “Gallery View” and select “View Video Participants Only,” will help viewers to prioritize the ASL interpreters. When presenting a slide-deck, Zoom attendees can select “Side-by-Side” view to ensure that ASL interpreters are still visible and can even pin the videos of the interpreters to their screen. Platforms such as Streamyard also allow you to choose a layout in which an ASL interpreter’s video screen is minimized but visible next to the main video screen.

Audio Descriptions

Audio descriptions in videos or presentations serve the same purpose as alt text for images. During a recorded video, audio descriptions of what is happening on screen enables people with blindness and low vision to engage more fully in media that is both visual and audial. Live visual descriptions in a zoom call might include describing one’s own appearance and video background and any visual graphics included in slide decks. Check out this example of audio descriptions during the ADA 30 Lead On Celebration this year. Disney has also committed to providing audio descriptions for many of their productions on the Disney Plus streaming platform.

Practice, Practice, Practice

Especially when it comes to planning live events, making sure that captioning and ASL interpretation are properly implemented can be difficult and any manner of things can go wrong (as with any aspect of event planning). Practicing and rehearsing your event in advance will help you prepare for what might go wrong with your accessibility technology. Also, the more events you host with accessible technology, the smoother your events will go!

3. Documents and Articles

Alternative Text

Much of the earlier conversation about image descriptions applies to images and logos included in documents. In documents, blog posts, and any other writing, make sure that your images are described. In Google, you can right click on an image and choose “Alt Text” to create an image description. Similarly in Microsoft Word, simply right click on an image and select “Edit Alt Text” to add a description.

Document Logic

Document logic means how you organize your document with titles, headings, and regular paragraphs. Both Google Docs and Microsoft Word allow you to change and create “Styles,” for all titles, headings, or normal text in a document. Using this feature to identify headings versus paragraphs of text helps screen readers understand how to correctly read different parts of a document. 

Plain Language

Earlier, we mentioned plain language when discussing Social Media. Plain language is about writing clear and concisely. Using plain language makes communications easy to understand for the general population, including people with intellectual and developmental disabilities and people who speak English as a second language. To learn more, check out this guide to writing in plain language from the Association of University Centers on Disabilities (AUCD). For examples of plain language writing, you can also check out this COVID-19 Guide in plain language created by the Green Mountain Self-Advocates on the COVID-19 or this Guide to Contacting your Representatives in Congress by AUCD.

Text Size

Many of us remember our parents or grandparents complaining about text that is too small to read or face this difficulty ourselves. More people have difficulty reading small text than you may think. According to the American Foundation for the Blind, 1 in 10 adults have trouble seeing even with glasses or contact lenses. Using a larger font helps so many people to more easily read your materials. Instead of 10 point font, consider 14 point font or larger (16 point or larger on websites). 

High Contrast

Using images with a high contrast of very light and very dark colors can be easier for folks with low vision to view. The same tip applies to choosing font and background colors. Stick to text and background combinations that have high contrast, for example black text on a white background or white text on a black background.

Descriptive Links

A screen reader will read out all text, so replacing long links in a document or social media post with a short description of the link can be extremely helpful for all readers. Whether or not you are using a screen reader, reading “learn more about describing links” is much more helpful than reading “learn more” or reading the full link, which I will spare you from. Check out Oregon State University’s summary of using links accessibly and this example a screen reader audio from Dallas College.

Accessibility Reviews

Some document editing softwares can automatically check how accessible the document is and let you know what can be improved. For example, in Microsoft Word, you can use the Word Doc Accessibility Checker under the  “Review” tab.  For example, the Accessibility Checker will tell you if you forgot alt text for an image or have unnecessary spaces in your document. Adobe Acrobat Pro, a PDF reader, also has an Adobe PDF Accessibility Checker.

4. Websites

Making websites accessible involves a combination of all of the accessibility tips and tools mentioned above. Typically, making websites accessible involves some knowledge of web design, but thankfully there are many companies and guides dedicated to making websites accessible. Here are some companies that can help you through the process of making your online presence accessible and inclusive:

• Siteimprove
• Make Sense: Better Web
• eSSENTIAL Accessibility

The basics of accessible website technology (check out Dreamhost for more items) are:

• Including alternative text for images and graphics
• Incorporating captions in videos
• Ensuring that users can navigate the website using the keyboard
• Using large enough fonts and high contrasting colors
• Avoiding tables of information except when communicating data points

5. Remote Working

COVID-19 has forced many workplaces to work remotely, increasing the need for organizations to proactively ensure that their systems and communications methods are accessible to people with a range of disabilities. For both in-person and remote working, the first step to making an inclusive workplace is asking employees what accommodations would help them be more successful, on a regular basis, and following through with requests. People often know what they need best, so asking is always a good place to start.

When it comes to making working from home accessible, ensuring digital accessibility through the methods mentioned earlier in this article is important, but not enough. Providing work schedule flexibility and offering to reimburse office furniture or any other accommodations needed are two ways to empower employees while working remotely. How many organizations have adapted to remote working has demonstrated how valuable and feasible work from home is as an accommodation. Making work from home accessible can help make more space for all employees to take care of their mental health. For more information on remote working an accessibility, check out these articles:

• Transitioning Your Office Online Must Work for All Employees
• 5 Ways to Support Remote Workers with Disabilities
• Accessible and Effective Remote Working

Start Somewhere

Making your digital presence accessible may take time, but the important thing is to start today, start with your next social media post, start with asking your employees about their accessibility needs. COVID-19 has brought so many challenges and tragedies to our world, but it has also given us an unlikely opportunity to transform the world we live in into a more inclusive and supportive world for everyone!

Notes:
1.  This article is far from comprehensive in covering digital accessibility technology and tools, please let us know what resources and tips you would like to share and anything that we are missing here. Email with additional recommendations to add to this blog at communications@aapd.com.

 2. A huge thank you to the AAPD staff for providing input and feedback for blog! For best practice on digital accessibility, watch how organizations by and for folks with disabilities center accessibility in their digital communications. Disability orgs don’t get accessibility perfect all the time, but following their example is a great start!

 3. Language accessibility is another massive barrier. In the U.S., 1 in 5 people speak a language other than English at home. As you consider ensuring that your digital work is accessible, it is also important to consider how you can create translations of your work and incorporate language interpretation when possible.

4. If you’re having difficulty convincing your organization to invest in digital accessibility for inclusion and civil rights alone, it can be helpful to point out how adding alt-text and improving web accessibility can improve your Search Engine Optimization and presence online! Check out these links for more information on digital accessibility:

• Digital Accessibility: What It Is and Why You Need It 
• Digital Accessibility 101

Ensuring People with Disabilities Can Access Prescription Drugs During the Current Crisis

March 13, 2020

Many people with disabilities are at increased risk of serious or fatal complications from COVID-19 (coronavirus). In an active community outbreak, the safest option may be to self-isolate at home, perhaps for weeks or longer. In order to prepare for this possibility, the CDC is currently recommending that people at high risk stock up on necessities, including maintenance prescription medication.

Unfortunately, many people with disabilities can’t take this advice because of insurance restrictions. Insurers typically refuse to cover refills on 30-day prescriptions until only three to seven days of medication remain. For certain controlled substance prescriptions, patients may be legally unable to fill a new prescription until the date that the previous prescription is scheduled to run out.

These coverage restrictions could leave many disabled people in danger. Visiting the pharmacy can be risky for some people with chronic illnesses in even a normal flu season. Some people with disabilities may also face logistical challenges in getting to the pharmacy if in-home support services become disrupted due to a local COVID-19 outbreak. While many people can use mail order pharmacies to avoid this risk, localized outbreaks and social distancing measures may disrupt supply chains. We cannot stake our lives on the assumption that the availability of medications will remain stable in the coming weeks and months. We need to be able to stock up now, as the CDC recommends.

Disrupting treatment always endangers patients, but even more so in a pandemic. COVID-19 is expected to heavily tax the resources of the health care system. The need for inpatient treatment will likely exceed capacity in many communities. Even outpatient clinics are likely to have a high number of patients seeking treatment for COVID-19 symptoms, making avoidable visits risky for those more vulnerable to complications. Additionally, patients whose chronic conditions are destabilized are in danger of becoming more severely ill if they are infected with COVID-19.

Fortunately, a few insurance companies have taken measures to protect patients. In both Massachusetts and North Carolina, Blue Cross Blue Shield has waived early refill limits on 30-day maintenance prescriptions. Recognizing that most of us cannot simply wait for our insurers to behave responsibly, the Washington state insurance commissioner issued an emergency order requiring insurers operating in the state to cover early refills. On March 10^th, the Center for Medicare and Medicaid Services issued guidance to Medicare Part D plans reminding them of their ability to relax restrictions on early refills and lift barriers to obtaining prescriptions from out-of-network pharmacies.

While these emergency policies still fail to provide sufficient protection for many people with disabilities taking prescribed controlled substances, they offer significantly more protection than the status quo.

To further safeguard access to treatment, there are some additional changes beyond allowing for early refills to standard insurance policy practices that would be beneficial. These include relaxing restrictions on prescription fills at out-of-network pharmacies and offering coverage of non-formulary drugs if supply chain issues leave patients with no available formulary options. Widespread adoption of such policies would go a long way toward protecting the lives of people with disabilities in the COVID-19 crisis.

Now is the time to reach out to your state’s insurance Commissioner to urge them to follow Washington State’s lead in requiring early refills and to take other measures designed to ensure at-risk populations are able to follow the CDC’s guidance. We’ve prepared a template for advocacy organizations to use to urge their state’s insurance commissioner to take these common-sense measures to protect those most at-risk.

While many states have already required insurers to cover COVID-19 testing and treatment without cost-sharing, insufficient action has been taken to ensure that people with disabilities have access to early refills sufficient to comply with CDC guidance.

You can download our template at this link and adapt it to your organization’s needs. These measures will work best if they are undertaken before an active community outbreak in your area. Since our community includes many of those who are most at risk from COVID-19, we urge disability advocacy groups to make this an area of focus in the coming days and weeks.

If your organization is engaged in advocacy on protecting people with disabilities from COVID-19 or if you have been successful at securing action from your state government, we urge you to share details of that through this form. AAPD will be maintaining a page keeping track of advocacy efforts and policy measures to protect the disability community for the duration of the crisis.

Ari Ne’eman is a Visiting Scholar at the Lurie Institute for Disability Policy at Brandeis and a PhD student in Health Policy at Harvard University. He is a member of the AAPD Board of Directors.

Kit Albrecht is a Research Associate at the Association for Autistic Community.