1. “where the rubber meets the road: The importance of Behind the Wheel Evaluations and Training” The Association for Driver Rehabilitation Specialists Annual Conference Buffalo, New York Presented by: Tommy Crumpton, LOT, MOT, CDI, CDRS August 3, 2014

2. ABSTRACT When considering whether your patient should be referred for a Driving Evaluation, there is often a dilemma as to what should be included, and how thorough the evaluation should be. This presentation will provide insight as to the importance of a behind-the-wheel assessment and training in conjunction with a clinical assessment in determining a patient’s risk level for driving

3. LEARNING OBJECTIVES 1. The participant will understand the similarities and differences between a Driving Evaluation and a typical Occupational Therapy Evaluation 2. The participant will understand the role of the Driver Rehabilitation Specialist as outlined in the ADED Best Practices for the Delivery of Driver Rehabilitation Services 3. The participant will understand what is assessed in a Behind-the-Wheel Evaluation 4. The participant will understand the process involved in Behind-the-Wheel Training 5. The participant will understand the patient’s legal responsibility when learning to drive or returning to driving with a medical condition

4. ANATOMY OF AN EVALUATION As Driver Rehab Specialists, we continually search for the “perfect” clinical evaluation tool that will answer every question about a person’s functional ability

5. Those of us who specialize in the field of Driver Rehabilitation have not found the clinical evaluation tool that measures a patient’s true driving risk potential

6. STANDARDIZED TESTING The framework or “skeleton” of an evaluation is a collection of various clinical assessment tools that we compile to determine if there is a deviation from a “normal” response

8. Functional Observation A patient’s functional ability is what we see or observe (the “skin) during an evaluation. We then correlate the clinical findings with the functional findings to get the whole picture

9. A Problem List is based on deficits identified during a Clinical Assessment A Treatment Plan is based on what we see through a Functional Assessment

10. * WITHOUT OBSERVING THE PATIENT’S PERFORMANCE OF AN ACTIVITY, THE EVALUATION IS INCOMPLETE *

11. Definition: “Where the Rubber Meets the Road” Fig. at the point in a process where there are challenges, issues, or problems. McGraw-Hill Dictionary of American Idioms and Phrasal Verbs © 2002 by The McGraw-Hill Companies, Inc.

12. Additional common uses of the phrase: Refers to the tire of a vehicle on the surface of a road “where it really counts”

13. * WITHOUT OBSERVING A PATIENT PERFORM THE TASK OF DRIVING, THE DRIVING EVALUATION IS INCOMPLETE AS WELL *

14. ADED BEST PRACTICES ACT The membership of ADED has developed the “Best Practices for the Delivery of Driver Rehabilitation Services” As a Driver Rehabilitation Specialist, when performing a Clinical or Behind-the-Wheel Evaluation and/or Training, this is the guide that should be used. It is an invaluable tool to help you develop your documentation form and to progress your program to a higher level.

15. ROLE OF THE DRIVER REHABILITATION SPECIALIST Evaluator Educator Teacher

16. WHAT DO WE DO IN A DRIVER REHABILITATION PROGRAM? We evaluate and train both experienced and inexperienced drivers with physical, cognitive, or a combination of physical and cognitive deficits

17. WHAT DOES A DRIVING EVALUATION INCLUDE? The evaluation actually consists of two (2) parts:

18. The Clinical Evaluation includes: General Information Medical History Current Status of Driver License Driving History Current physical, visual, and cognitive status as they relate to driving

19. The Behind-the-Wheel Evaluation includes: A performance based assessment Safely performing a series of maneuvers (Foundation Skills) that every driver must be capable of doing The setting is determined either by driving experience, or whether adaptive equipment will be needed

20. For inexperienced drivers or those needing adaptive equipment, a parking lot only evaluation is done When evaluating a patient’s cognitive status, and/or minor physical deficits, the full evaluation route is 20 miles long, takes over an hour to complete, and is performed in a variety of normal driving settings

21. FOUNDATION SKILLS OF DRIVING Steering Braking Accelerating Lane Positioning Left Turns Right Turns Backing Use of Turn Signals Checking Blind Spot Reading the Terrain Changing Lanes Parking Decision Making

22. GOOD NEWS / BAD NEWS When a person successfully demonstrates driving ability, there is : GOOD NEWS: They are considered by you to be a safe driver. BAD NEWS: They may still have to prove it to the Licensing Agency.

23. RECOMMENDATION CHOICES BASED ON THE EVALUATION 1.Resume driving after completing required Department of Public Safety testing 2.Return for follow-up training, then complete required Department of Public Safety testing 3.Driving is not recommended and the patient should retire from driving

24. FOLLOW-UP TRAINING (THERAPY BEHIND THE WHEEL OF A CAR) The number of hours will be estimated by the therapist Training is specific to the needs of the individual patient If adaptive equipment is needed, training will be recommended

25. In all cases of Behind-the-Wheel training, the core function of a Driver Rehabilitation Program is to train the brain to do something it has never done before or to perform it in a way different than originally learned

26. LEGAL RESPONSIBILITY WHEN RETURNING TO DRIVING WITH A MEDICAL CONDITION Texas Department of Public Safety and Texas Department of Health Services Guidelines

27. DEPARTMENT OF PUBLIC SAFETY TESTING The Department of Public Safety (DPS) and the Department of Public Health (Medical Advisory Board) guidelines are that when there is a change in a person’s mental or physical condition that could affect his/her ability to operate a vehicle safely, they are responsible for informing the DPS and completing any testing that may be required

28. The Department of Public Safety is the only legal authority over a person’s Driver License The Adaptive Driving Program does not substitute for DPS testing

29. QUESTIONS???