1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 10 Assessing Environment: Home, Community, and Workplace Access and Safety

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives Describe the roles and responsibilities of the occupational therapist in the evaluation of environmental access. Identify factors that act as environmental or contextual enablers or barriers/hindrances to occupational performance. Identify environmental features that influence the safety of the client and the occupational therapist. Apply critical appraisal when selecting assessment instruments appropriate for use in evaluating access to home, community, and workplace. Explain how legislation and building standards influence the degree of environmental access that is available for people with disabilities.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation of the Environment Occupational functioning is influenced by the context of the client’s environment. Assessment of attributes of the environment should be augmented by who will use the environment and the functions they will carry out there.

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Client-Centered Approach The client–therapist interaction begins with an interview and assessment so that the therapist can gain an understanding of the client’s occupational profile. The client-centered approach determines the roles and occupations the client previously had and what the client wants or is expected to be able to do. Collaborative goal setting is important in establishing this approach successfully. Occupational therapists complete analysis of occupational performance, including environmental assessment, to determine client’s abilities and capacities.

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Roles The roles carried out by clients address purposeful activities related to self-maintenance, self-enhancement, and self-advancement. Specific features of the environment can support or hinder the fulfillment of valued roles within the home, community, and workplace.

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Environmental Barriers and Supports The International Classification of Functioning, Disability and Health classifies environmental factors as assistive products and technology; the natural and human-made environments; supports and relationships; attitudes; and services, systems, and policies. Therapists must be able to identify the key environmental barriers and supports that influence the occupational functioning of clients. Improved accessibility through the use of universal design and barrier-free design is preferable.

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Influences on Environmental Accessibility and Safety Various societal and cultural attitudes influence the degree to which the physical environment is made accessible, inclusive, and safe for people with disabilities. Influences manifest as national and state legislation, building standards, and professional practice requirements.

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Legislation United Nations Convention on the Rights of Persons with Disabilities (2006) Americans with Disabilities Act (ADA, 1990) Canada’s Ontarians with Disabilities Act (2001) –Both laws designed to enable the participation and inclusion of people with disabilities in society –Titles II and III detail the steps to be taken by public and private sector services, programs, and facilities to comply with and implement the requirements of the ADA. Occupational therapists are skilled in occupational analysis, environmental assessment, and determining PEO fit and are well suited to assist with meeting the requirements of the legislation.

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Building Standards Updated ADA-ABA (Architectural Board Act) Accessibility Guidelines for new or altered building –Suggestions for “readily achievable” access solutions –Occupational therapists can assist businesses to use this tool and set priorities for achieving accessibility.

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Professional Practice Requirements Standards of practice, core competencies, and functions expected of therapists are developed at the national and state level and provide performance criteria. Knowledge of and ability to perform assessments of context/environment are considered to be core competencies and functions of practice for all occupational therapists.

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Environment Assessment Ideally, the occupational therapist should select instruments with standardization that assess person- environment-occupation (PEO) fit. There are few measures that have been developed to assess this complex PEO relationship.

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Home Important component of the occupational therapy process Often completed as a part of the discharge planning process Purpose is to identify the degree of fit for the person, the completion of his or her daily roles, and the home environment.

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Home— (cont.) Ensuring that clients’ home environments are able to provide them with supports they need is important to enabling the client to continue living at home safely. Recognize that people have great attachment to their homes. Clients belongings and how their home looks are meaningful to them.

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Home— (cont.) Specific assessments –SAFER-HOME –HOME FAST –Westmead Home Safety Assessment –I-HOPE –Home Safety Self Assessment Tool

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Home— (cont.) Self-assessment guides –Maintaining Seniors’ Independence: A Guide to Home Adaptations –Maintaining Seniors’ Independence through Home Adaptation: A Self-assessment Guide –A Consumer’s Guide to Home Adaptation

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Home— (cont.) Home safety and fall prevention –Home assessments reduce the risk of falls, especially in people who have a history of past falls. –Home environmental interventions are also effective in preventing falls in older adults, particularly those who are at high risk of falls.

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Home— (cont.) Housing options –U.S. Office of Fair Housing and Equal Opportunity administers legislation and policies that ensures equal access to housing. –Home and community settings can present risks because they are complex and often unfamiliar to the therapist.

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Community Occupational therapists are involved in changing environments to enable their clients’ participation and fulfillment of community roles. Therapists can assume consultation or advocacy roles with groups seeking to make educational, cultural, commercial, and religious facilities accessible. Universal design principles are now being applied across most community settings Occupational therapists play important role in promoting this mainstream approach to design.

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Community— (cont.) Specific assessments and tools –CHIEF –Facilitators and Barriers Survey –Measure of Quality of the Environment –Multidimensional Scale of Perceived Social Support –Home and Community Environment Instrument

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Workplace Occupational therapists play an important role in enabling clients to fulfill self-advancement roles by assisting them to seek or return to work. Workplace assessment is a key step in helping learn how workplace factors impact work performance and safety. It is important to assess the sociocultural environment, including social supports, staff interactions, and attitudes of coworkers and supervisors. Knowledge of the ADA and supporting guidelines is critical. A range of strategies such as workstation modifications and assistive technologies can be implemented to reduce performance barriers.

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment of Access to Workplace— (cont.) Specific assessments or tools –Americans with Disabilities Act Checklist for Readily Achievable Barrier Removal –ADA Work-Site Assessment –Job Analysis during Employer Site Visit –Work Environment Scale –Work Experience Survey –Workplace Environment Impact Scale

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins General Comments on Assessing Access to Home, Community, and Workplace Many therapists rely on experience, observation, and interviews when called on to evaluate the environment. These methods cannot stand alone as a part of best practice in occupational therapy. Use of standardized instruments that have evidence of acceptable measurement properties is also necessary.