Evaluating accessibility in the world around you: Assessment tools and approaches for public spaces, home residences, products, information, and educational materials Rochelle Mendoca, PhD, OTR/L Roger Smith, PhD, OT, FAOTA, RESNA Fellow Noralyn Pickens, OT, PhD Denis Anson, MS, OTR, RESNA Fellow Jaclyn Schwartz, MSOT, OTR Linda Struckmeyer, MA, OTR/L, ATP

Agenda Introduction Overview of accessibility and universal design Residential spaces Public spaces Information accessibility Learning and education accessibility Product accessibility Wrap-up

Residential Assessments Noralyn Pickens and Linda Struckmeyer

Approach Context of evaluation provision Degree of client – centeredness Degree of PEO Skills of therapist/evaluator Range of tools Availability Will approach the tools from the context of service delivery – acute care, rehabilitation, home health, and home modifications specialist Focus of assessment – House Structure, Safety, Occupational performance, Client preferences,… Where is the PEO fit for each assessment What skills and training do the evaluators need? OT specific? General popoulation? Home Specialist? Next slide the range of tools across these dimentions….

Acute Care Rehabilitation Home Health Care Home Mod Specialist AARP COUGAR SAFER-HOME HEAP I-HOPE WESTMEADE CASPAR

AARP Home Safety Checklist Purpose: Assess safety and comfort of home for well elderly with minor impairments Context for assessment: Acute, Rehab, HH PEO: Occupation orientation Developed: Updated 2011, caregiver checklist 2007 Description: Client assesses accessibility and safety of home by answering questions such as “Are cabinets and cupboards easy to open?”; if the answer is “no”, suggestions for improvements or modifications are made. AARP. http://www.aarp.org/home-garden/livable-communities/info-07-2011/make-your-home-a-safe-home.html LINDA

SAFER-HOME v3 Purpose: Assesses client’s ability to safely carry out functional activities in the home and evaluates effectiveness of modifications as an outcome measure Context for assessment: Rehab, HH PEO: Occupation orientation Developed: 2006 (v3) Description: Using interview and observation of client participating in activity, assesses 75 items around the home; level of safety risk is scored on a 4-point (0-3) scale Chiu, T., & Oliver, R. (2006). Factor analysis and construct validity of the SAFER-HOME. OTJR: Occupation, Participation & Health, 26(4), 132-142. NORALYN – Earlier rendition - SAFER Tool manual review – Easy to teach new practitioners Scoring system – Outcome measure- In my research –sensitive to change in areas of Mobility, Environmental hazards, and Bathroom and toilet

Home Environment Assessment Protocol (HEAP) Purpose: Assesses home environment of people who have dementia for safety hazards and provides recommendations for home modification Context for assessment: Rehab, HH PEO: Person centeredness revolves around caregiver, Occupation centered , environment is considered a treatment modality Developed: 2002 Description: Information on 192 items in eight areas of the house are rated through caregiver interview, direct observation with caregiver clarification, and direct observation ; presence or absence of safety hazards, adaptations, visual cues, and comfort are scored as present or not Gitlin, L ., & Corcoran, M. (2005) . Home Environment Assessment Protocol (HEAP) Assessment in Occupational Therapy in Dementia Care. Bethesda, MD: AOTA LINDA

In-Home Occupational Performance Evaluation (I-HOPE) Purpose: measure in-home activity performance and change in fit of P-E before and after home modification interventions Context for assessment: Rehab, HH, Home mod specialist PEO: client-centered/occupation orientation Developed: ©2011 Description: card sort followed by prioritizing, identifying level of satisfaction and observation of activities, identifying barriers to participation Stark, S. L., Somerville, E. K., & Morris, J. C. (2010). In-home occupational performance evaluation (I-HOPE). American Journal of Occupational Therapy, 64, 580-589. doi: 10.5014/ajot.2010.08065 LINDA Older adults 60 minutes (+)

I - HOPE Card sort- step 1

Westmead Home Safety Assessment (WeHSA) Purpose: Systematically identify fall hazards in a client’s home for any client at risk for falls Context for Assessment: HH, Home mod specialist PEO: client-centered/ environment orientation Developed: 1997 Description: 72-item inventory/checklist that identifies relevance of item to client and rates as a hazard (with type of hazard listed) or not a hazard Clemson, L., Fitzgerald, M., & Heard, R. (1999). Content validity of an assessment tool to identify home fall hazards: the Westmead Home Safety Assessment. British Journal of Occupational Therapy, 62(4), 171-179. NORALYN – also a strong teaching tool with a specific focus on Falls Addresses multifactorial aspects of falls Score as relevant or not relevant – If relevant then score if hazard or no hazard – then type of hazard

COUGAR Purpose: Occupational therapy assessment of safety in the home for a variety of clients (Fisher, et al, 2007) Context for assessment: Acute, Rehab, HH PEO: Occupation orientation When developed: 2007 (v2.0) Description: Assessment of 52 items through observation, testing and questioning resident in the categories of fire and carbon monoxide hazards, emergency/medical, electrical/water temperature, flooring/hallways, kitchen, bathroom, closets/storage, parking areas, and entrances; marked as safe or unsafe with comments Fisher, G., Baker, A., Koval, D., Lishok, C., & Maisto, E. (2007). A field test of the Cougar Home Safety Assessment (version 2.0) in the homes of older persons living alone. Australian Occupational Therapy Journal, 54(2), 124-130. NORALYN – Version 4.0 out; with most development data on the 2.0 version Tour the home / interview – SAFETY focus Clinical reasoning to determine if Safe or Unsafe Areas of safety not found in other assessments House structure focused

Context for assessment: Home mod specialist Purpose: Assesses tasks done by resident in the home for problems/difficulties; appropriate for clients with a variety of impairments Context for assessment: Home mod specialist PEO: Occupation orientation When developed: 2001 Description: Identifies each task as a problem to do independently, if someone helps the client complete the task, and if a device is used; problem areas are ranked according to urgency of need for change; client offers ideas for change in problem areas; therapist takes photos and measurements of problem areas for construction specifications (Sanford, et al, 2002) Sanford, J.A., Pynoos, J., Tejral, A., & Browne, A. (2002). Development of a comprehensive assessment for delivery of home modifications. Physical and Occupational Therapy in Geriatrics, 20(2), 43-55. NORALYN – Developed by multi-discplinary team including architect, OT Client centered Multiple steps: After interview (1, 2, 3)and addressing safety and performance issues the client rates the problems (step 4) he or she wants changed (range from no change to change now – and then Rank) Then go in the home to evaluate structure (step 5)– using judement as to whether you request client performance (I don’t think it was intended for performance, but an OT would naturally do this). Summary of recommendations is Step 6

References for residential tools AARP. http://www.aarp.org/home-garden/livable-communities/info-07-2011/make-your-home-a-safe-home.html Chiu, T., & Oliver, R. (2006). Factor analysis and construct validity of the SAFER-HOME. OTJR: Occupation, Participation & Health, 26(4), 132-142. Clemson, L., Fitzgerald, M., & Heard, R. (1999). Content validity of an assessment tool to identify home fall hazards: the Westmead Home Safety Assessment. British Journal of Occupational Therapy, 62(4), 171-179. Fisher, G., Baker, A., Koval, D., Lishok, C., & Maisto, E. (2007). A field test of the Cougar Home Safety Assessment (version 2.0) in the homes of older persons living alone. Australian Occupational Therapy Journal, 54(2), 124-130. Gitlin, L ., & Corcoran, M. (2005) . Home Environment Assessment Protocol (HEAP) Assessment in Occupational Therapy in Dementia Care. Bethesda, MD: AOTA Gitlin, L.N. (2002). Evaluating home environments of persons with dementia: Interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP). Disability and Rehabilitation, 24, 59-71 Sanford, J.A., Pynoos, J., Tejral, A., & Browne, A. (2002). Development of a comprehensive assessment for delivery of home modifications. Physical and Occupational Therapy in Geriatrics, 20(2), 43-55. Stark, S. L., Somerville, E. K., & Morris, J. C. (2010). In-home occupational performance evaluation (I-HOPE). American Journal of Occupational Therapy, 64, 580-589. doi: 10.5014/ajot.2010.08065