Change in the Locker Room: Environmental Modifications to Support Swimming Participation and Reduce Caregiver Burden Kimberly Lindgren, MOTS1; Gretchen Stuenkel, MOTS1; Kathleen Thorsos, MOTS1; Michelle Wells, MOTS1 Faculty Adviser: Tracy Jirikowic, PhD, OTR/L1, Community Mentors: Billie Otter, OTR/L2; Erica Woodcock3 1Department of Rehabilitation Medicine, University of Washington, Seattle, WA; 2Maple Valley Pediatric Therapy, Maple Valley, WA; 3South Sound Swim School, Auburn, WA Environmental features limit access and usability . In order to participate in swimming, one must engage in transitional occupations such as dressing and showering. Citation from Lit review: Umedat et al (2017): barriers to community participation, including physical environment, social behaviors, policy, safety Hallgrimsdottir, Svensson, & Ståhl (2015): supportive environment facilitating community participation PURPOSE Increase the usability of a pool facility to support performance of occupations such as dressing, showering, and toileting for children with and without disabilities. Facilitate safety and wayfinding during transitions. Reduce caregiver burden experienced during pool transitions and routines. Improve usability and accessibility for all users. Promote swimming participation. PROCESS RECOMMENDATIONS IMPLEMENTED Environmental Barrier or Challenge Implementation Changing Area in Locker Room Limited safe sitting areas Installation of bench Limited areas to change in privacy Privacy curtain in changing area Elopement risk for small children Wall-mounted child safety seat Lack of family restroom for opposite-sex caregivers Policy changes, signs to announce presence of opposite-sex caregiver Showers in Locker Room Caregiver gets wet while assisting child with showering Hand-held shower heads Shower curtain Risk of falling due to slippery floors Floor treatment to ↑ friction Limited areas for showering materials Shampoo racks Hooks Toilets and Sinks Stall latches are not usable for all Flip latch Soap dispensers are too far to reach Relocate soap dispenser Step-up stool for small children Individual pump soap Pool Risk of drowning No visual cues for safety Painted line around pool acting as visual cue for safe transitions Consultation with Stakeholders Focus Group Interviews Creation of Environmental Modification Recommendations Feedback Sessions with Community Mentors and Camp Director Final Recommendations Implementation Parent Surveys BACKGROUND Swimming is a form of exercise and community participation, which typically requires transitions involving bathing and dressing. The environmental features of a pool facility can support or hinder these occupations.1 We partnered with Maple Valley Pediatric Therapy, South Sound Swim School, and Black Diamond Camps to develop environmental modifications to support swim participation and functional performance of child-parent co-occupations. Pool users included children receiving adapted swim lessons from an occupational therapist (OT), children in typical swim classes, a senior water aerobics group, 3,000 summer campers, and as many as 4,500 weekend retreat participants each year. In evaluating potential environmental modifications to the site, we focused on the needs of swim lesson participants and their families, while also keeping the needs of this broader population in mind. CHEC Assessments KEY FINDINGS CHEC usability assessments revealed mobility and vision barriers. Mobility barriers included: lack of grab bars in stalls, soap mounted out of reach for wheelchair users (and small children), and uneven flooring. Vision barriers included: low lighting, minimal contrast, and small signage font. Parent survey identified environmental barriers to dressing. Parent survey identified environmental barriers to showering, including: getting wet when turning on showers for children, non-adjustable water temperature in showers, and slippery floors. 84% of parents supported policy changes allowing opposite-sex caregivers to assist children in the locker room. These policy modifications will promote participation in swim lessons and reduce caregiver burden. Parent Concerns Related to Dressing at the Pool FUTURE RECOMMENDATIONS NEEDS ASSESSMENT We conducted a literature review and gathered information from pool users and project stakeholders to develop environmental recommendations. Focus Group Interviews: A convenience sample of 9 parents participated in interviews regarding locker room usage and areas of concern. Parent Survey on Locker Room Usage: Surveys developed from focus group input were distributed to parents; 45 surveys were completed. Parent Survey on Locker Room Policies for Opposite-Sex Caregivers: Initial parent surveys identified challenges for opposite-sex caregivers to assist children. A follow-up survey assessed the acceptability of low cost policy changes to address these concerns; 25 surveys were completed. The Community Health Environment Checklist (CHEC):2 We used the CHEC to assess whether the facility enabled visitors with mobility impairments, low vision, or hearing limitations to get in, do what they need to do, and get out of the pool facility without much difficulty. Identification of Priorities: Meetings with the camp director, OT, and swim instructor were held to identify priorities within the available budget. Environmental Barrier or Challenge Recommendation Additions to Existing Facility No grab bars in bathroom stall Insufficient lighting Building entry, pathway to pool, and locker room labels are unclear Grab bars in bathroom stalls ↑ global lighting in locker room Lighted pathways ↑ signage Major Renovations Narrow stalls (toilets and showers) No opposite-sex caregiving space Limited privacy Risk of elopement Construction of family locker room with accessible shower, toilet, and changing bench = environmental deficits or safety risk in facility = implemented environmental modifications = environmental modification not yet implemented REFERENCES Rimmer, J.H. (2016). Equity in active living for people with disabilities: Less talk and more action. Preventative Medicine, 95, S154-S156. doi: 10.1016/j.ypmed.2016.12.037. Stark, S., Hollingsworth, H. H., Morgan, K. A., & Gray, D. B. (2007). Development of a measure of receptivity of the physical environment. Disability and Rehabilitation, 29(2), 123-137.