1. 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

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

3. Residential Assessments
Noralyn Pickens and Linda Struckmeyer

4. 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….

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

6. 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.
LINDA

7. 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),
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

8. 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

9. 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, doi: /ajot
LINDA
Older adults
60 minutes (+)

10. I - HOPE
Card sort- step 1

11. 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),
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

12. 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),
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

13. 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),
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

14. References for residential tools
AARP.
Chiu, T., & Oliver, R. (2006). Factor analysis and construct validity of the SAFER-HOME. OTJR: Occupation, Participation & Health, 26(4),
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),
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),
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),
Stark, S. L., Somerville, E. K., & Morris, J. C. (2010). In-home occupational performance evaluation (I-HOPE). American Journal of Occupational Therapy, 64, doi: /ajot