Assessing Environment: Home, Community, and Workplace Access and Safety OT 211 PDF

Assessing Environment: Home, Community, and Workplace Access and Safety OT 211 Dr. Qussai Obiedat  INTRODUCTION Occupational Person Occupation Performance Environment...

Assessing Environment: Home, Community, and Workplace Access and Safety OT 211 Dr. Qussai Obiedat  INTRODUCTION Occupational Person Occupation Performance Environment (Law et al, 1996) 2  INTRODUCTION The environment influences human behavior and provides the context within which all occupational roles are performed Ingrained into may frameworks and models that guide OT practice There are physical, social, cultural, institutional, and temporal dimensions that influence performance and engagement at a personal, community, and societal level Environmental barriers (hindrances): can be modified or eliminated easier than most other negative influences for people with disabilities Environmental supports (enablers): promote optimal engagement in occupation 3  HOW DOES OT PLAY A ROLE? Analyze the Person-Environment-Occupation relationship & the level of congruency (PEO fit) The better the fit, the more optimal the occupational performance Through assessment of the environment’s supports and barriers, the OT can determine occupational functioning and develop strategies to eliminate barriers and use resources and supports to improve function To assess the environment and PEO relationship, identify and evaluate: Environmental barriers that may challenge the competency and ability of individuals to carry out their role Environmental resources that will support occupational performance and functioning 4  EVALUATION OF THE ENVIRONMENT The environment provides the context for occupational functioning Assessing its attributes should include: Who will use the environment What functions will be carried out in the environment Utilize a client-centered approach for assessment through all stages in the process to gain an understanding of the occupational profile 5  CLIENT-CENTERED APPROACH Collaborative goal setting is essential for client-centered therapy Occupational Profile: Determine the roles and occupations the client previously held What does the client currently want or is expected to be able to do? Analysis of Occupational Performance: What are the client’s performance skills, patterns, and challenges, considering the contexts within which activities and roles will be carried out Environmental assessment Roles address purposeful activities related to self-maintenance, enhancements, and self- advancement that have different meanings to each individual 6  BARRIERS & ENABLERS The International Classification of Functioning, Disability, and Health (ICF) classifies environmental factors as the natural and human-made environments; assistive products and technology; supports and relationships; and services, systems, and policies Stairs vs. elevators, rocky paths vs.ramps Access that is discriminatory or inconvenient is no longer considered a viable solution to eliminating access barriers Universal design and barrier-free design is preferred to improve accessibility Universal design (UD): features of the built environment that enhance optimal function and convenience for everyone, regardless of ability; preferred method Barrier-free design: features of the built environment that remove physical barriers to allow full and equal accessibility for all persons with disabilities (PWD) 7  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 Consider national and state or provincial legislation, building standards, and professional practice requirements Legislatively, the United Nations Convention on the Rights of Persons with Disabilities (PWD) promotes, protects, and ensures the full and equal enjoyment of all human rights and fundamental freedoms by all PWD and to promote respect for their inherent dignity 8  LEGISLATION The United States and Canada designed a disabilities act to enable the participation and inclusion of people with disabilities in society called the Americans with Disabilities Act (ADA) and Ontarians with Disabilities Act, respectively These laws obligated society to provide reasonable accommodations to ensure that public services, facilities, transportation, employment, accommodations, and telecommunications are accessible Titles II and III of ADA address the required accommodations and availability of resources; modifications to policies, practices, and procedures; the removal of barriers; and alternative forms of services ADA results mixed but changes to attitudes and practices of Americans improved quality of life for PWD 9  LEGISLATION-HCD In Jordan, the Higher Council for the Rights of Persons with Disabilities (HCD) is the governing body responsible for the rights of PWD. Vision: A society in which people with disabilities have a decent and sustainable life that will grant them effective participation based on equity and equality Mission: Policy-making, planning, coordination, follow-up, and support for all activities that serve Persons with Disabilities through the adoption of participatory management, wise governance, accountability, and transparency. Law on the Rights of Persons with Disabilities No. 20 for the Year 2017 The removal of physical and behavioral barriers for PWD, that include a lack or absence of reasonable accommodation or accessible formats or accessibility as well as individual and institutional behaviors and discriminatory practices on the basis of disability. 10  LEGISLATION-HCD Reasonable Accommodation: The alteration of the environment or time-related conditions within a specific context of time or place to enable the person with a disability to practice a right and freedom, or to gain access to services on an equal basis with others. Accessible Formats: The transformation of information, data, pictures, drawings and other classified items to Braille, or large print, or the transformation of information into electronic or audio formats, or translating into Sign language, or using simplified language, or clarifying the information in any other manner without making any change in the essence or meaning in order to enable persons with disabilities to review and understand the issue. Accessibility: The construction of buildings, roads, facilities, and other public and private sector venues in a way that is accessible to all the public, and making adjustments in accordance with the Building Code Requirements for Persons with Disabilities as issued in the provisions of the Jordan National Building Code and any other special standards issued or approved by the Council. Universal Design: The adjustment of goods and services in their initial phases of design and production to allow for utilization of such services and goods in a manner accessible to everyone. Disabled People’s Organizations: The societies, clubs, federations, non-profit companies and other non-government entities registered and licensed according to the provisions of legislation in effect and whose board of directors mainly consists of persons with disabilities one of whom presides such board. These organizations are intended to reinforce the rights or enablement or facilitate access to services or implement disability-related programs. 11  BUILDING STANDARDS The U.S. Access Board released the updated ADA-ABA (Architectural Board Act)) Accessibility Guidelines for new or altered buildings, which provide the accessibility requirements for public and private facilities Based on adult and child dimensions and anthropometrics Includes space for maneuvering wheelchairs in corridors and rooms, washrooms, building entrances, and parking lots National Institute of Occupational Safety and Health (NIOSH) publishes criteria directed at reducing the rate of workplace injuries The Americans with Disabilities Act Checklist for Readily Achievable Barrier Removal developed for owners and managers of public buildings and businesses to identify barriers in their facilities 12  ADA-ABA GUIDELINES Minimum of 30 x 48 inches (760 x 1220 mm) for maneuvering a wheelchair in a clear space forward or parallel approach in a corridor or doorway Minimum of 42 inches (1065 mm) at the approach to a turn Minimum of 48 inches (1220 mm) at the turn 13  ENVIRONMENT ASSESSMENT Ideally, select instruments with standardization that assess PEO fit PEO relationship is dynamic, complex, and interwoven and can therefore be difficult to measure Following measures are divided by setting: 1. Homes 2. Communities 3. Workplace 14  ASSESSMENT OF ACCESS TO HOME Home-based performance assessments provides an accurate reflection of the clients’ ability to manage in that setting Individualized approach to assessing the degree of fit for the person, the completion of their daily roles, and the home environment Must ensure that clients’ home environments can provide them with the necessary supports to continue living at home safely Remember that clients have attachments to their homes, thus therapists must demonstrate sensitivity to their clients’ perspectives about their homes 15 HOME ASSESSMENTS 16  THE HOUSING ENABLER Questionnaire to assess the congruence between an individual with a functional impairment and their home environment Measures functional limitations (15 items) and physical environmental barriers (188 items) Scoring: dichotomous ratings for steps 1 and 2, step 2 ordinal scale; summary scores are best calculated with software Range of scores: dependent on number of functional limitations, use of mobility aids, and number of environmental barriers Time to administer: up to 2 hours 17  HOME FALLS AND ACCIDENTS SCREENING TOOL (HOME FAST) Healthcare provider completed questionnaire designed to identify risk of falls as a result of home hazards May be used as an outcome measure to evaluate interventions for improving function in the environment Scoring: nominal Range of scores: 0-25, indicating the number of items for which hazards are identified Time to administer: 20-30 minutes 18  SAFETY ASSESSMENT OF FUNCTION AND THE ENVIRONMENT FOR REHABILITATION HEALTH OUTCOME MEASURE SAFER-HOME is designed to measure intervention effectiveness and changes in safety intervention over time 12 domains: living situation, mobility, environmental hazards, kitchen, household, eating, personal care, bathroom and toilet, medication, addiction, abuse, leisure, communication and scheduling, and wandering Scoring: ordinal Range of scores: 0-228 Time to administer: 45-90 min 19  WESTMEAD HOME ASSESSMENT Assessment to identify fall hazards in the home environments of older adults Scoring: nominal Time to administer: one home visit 20  THE SAFE LIVING GUIDE: A HOME HAZARD CHECKLIST FOR SENIORS Self-completed questionnaire; designed to identify potentially hazardous areas in the home Scoring: dichotomous Time to administer: 25-30 min 21  ASSESSMENT OF COMMUNITY ACCESS OTs are involved in changing environments to enable their clients’ participation and fulfillment of community roles. Community, businesses, services (including public transportation) and programs must be made accessible for PWD. OTs can assume consultation or advocacy roles with groups seeking to make educational, cultural, commercial, and religious facilities accessible. 22 COMMUNITY ASSESSMENTS 23  CRAIG HOSPITAL INVENTORY OF ENVIRONMENT FACTORS (CHIEF) Assessment of the frequency and magnitude of environmental characteristics that act to impede accomplishment of daily activities and social roles Five categories: attitude and support, services and assistance, physical and structural policy, and work and school Self-administered (5-10 min) or administered by interview (10-15 min) Full CHIEF = 25 items; short form = 12 items 24  FACILITATORS AND BARRIERS SURVEY/MOBILITY FABS/M is a self-report survey of environmental facilitators and barriers to participation with mobility impairments (e.g., stroke, cerebral palsy, polio, and spinal cord injury) 133 items in six domains: personal mobility device, home-built features, community built and natural features, community destinations access, community facilities access, and attitudes Time to administer: 40-60 min 25  MEASURE OF QUALITY OF THE ENVIRONMENT (MQE) VERSION 2 Measures environmental facilitators and obstacles to social participation and accomplishment of daily activities Six categories: support and attitudes of family, job and income security, government and public services, physical environment and accessibility, technology, and equal opportunity and political orientations Interview format Time to administer: 10-30 min 26  THE MULTIDIMENSIONAL SCALE OF PERCEIVED SOCIAL SUPPORT (MSPSS) Assessment of perceptions of social support from three sources: family, friends, and significant other Inventory/list of 12 statements of relationships Rated on 7-point Likert scale Time to administer: 2-5 min 27  ASSESSMENT OF ACCESS TO WORKPLACE OTs are crucial in enabling clients to fulfill self-advancement roles by assisting them to seek or return to work Workplace environments can differ significantly, and the needs of clients will differ depending on the nature of their condition thus requiring assessment Assess sociocultural environment – social supports, staff interactions, and attitudes of coworkers and supervisors Work assessments can be used for challenges with volunteering or attending school 28 WORKPLACE ASSESSMENTS 29  CHECKLIST OF HEALTH PROMOTION ENVIRONMENTS AT WORKSITES (CHEW) An observational measure of environments (in and around work sites); designed to assess environmental influences on health behaviors and evaluate health promotion programs Scoring: separate scores computed for each content area (physical, information, neighborhood, and surroundings); summary scores computed for physical and information domains Time to administer: 20-50 min 30  ENVIRONMENTAL ASSESSMENT TOOL (EAT) Observation-based assessment designed to measure work site physical, social, and institutional environmental supports that may influence health behaviors and capture change across time Scoring: dichotomous Range of scores: 0-100 points, divided among three subscales; scores weighted within each subscale Time to administer: variable with work site 31  WORK ENVIRONMENT SCALE (WES) VERSION 4 Measures the social environment of all types of work settings 10 subscales, 3 sets: the relationship dimensions, the personal growth or goal orientation dimensions, and the system change dimensions For evaluation of productivity, employee satisfaction, employee expectations, and programs Time to administer: 15- 20 min per form, 5-10 min to score 32  WORK EXPERIENCE SURVEY Interview use to identify job accommodation needs Work site accessibility, performance of essential job functions, job mastery, and job satisfaction Time to administer: 30-60 min 33  WORKPLACE ENVIRONMENT IMPACT SCALE (WEIS) V. 2 Semi-structured interview; addresses individuals’ experiences and perceptions of their work environments Designed for use with individuals with physical or psychosocial disabilities; for use with individuals who are employed or are planning to return to work after an interruption in employment caused by injury or illness Scoring: 4-point ordinal scales (17 items) Time to administer: 30-45 min for interview, 15 min for scoring 34  WORKER ROLE INTERVIEW V. 10 Semi-structured interview designed to identify potential barriers that will interfere with return to work Scoring: 4-point ordinal scale (17 content area) Time to administer: 45-60 min 35 Thank You! 36