ASSESSMENTS
Home Safety and Accessibility Assessments
The process of selecting an assessment that will provide the most valuable information for addressing a client’s home modification needs may depend on the clinical utility of the assessment; its applicability to particular populations or situations; and the client’s occupational performance, including any intrinsic or extrinsic factors that may impact independence (Christensen & Chase, 2011).
A variety of environmental assessments designed for older adults exists, such as the In-Home Occupational Performance Evaluation (I-HOPE; Stark, Somerville, & Morris, 2010), Safety Assessment of Function and the Environment for Rehabilitation—Health Outcome Measurement and Evaluation (SAFER-HOME; Chiu et al., 2006), and the Home Falls and Accidents Screening Tool (Home FAST; Mackenzie, Byles, & Higginbotham, 2000).
Each assessment examines the degree of fit between a person and the environment differently. For example, the I-HOPE identifies the performance difficulties an individual faces in his or her home, with the therapist observing for barriers that impact the client’s performance during problematic activities; each barrier yields a score measuring the level of severity. In contrast, the SAFER uses interviews and observation of task performance to assess functional performance and safety concerns. The characteristics and age of the client are important considerations when deciding which tool to use. For example, the SAFER does not fully address personal care and food preparation, but addresses mobility, household, and bathroom safety; the I-HOPE is meant for higher functioning individuals and is not compatible for clients with dementia or pediatric clients.
The Measure of Environmental Qualities of Activity Settings (MEQAS)
The MEQAS is an assessment tool that I was introduced to in my Environmental Determinants course when we completed it as an assignment (attached below).
The MEQAS-32 is an objective, observer-rated measure of the environmental qualities of youth leisure or recreational activity settings (King, Rigby et al., 2014). Activity settings are the places and spaces in which children or youth “do things”, including both active and passive pursuits. Activity settings are comprised of the observable features and the perception of the possible experiences that could arise from engaging in a particular activity at a specific time in a specific place (Heft & Chawla, 2006; Rivera et al., 2005; Spencer & Blades, 2006). Environmental qualities of activity settings encompass (1) place-related qualities (aesthetic, physical, and social) and (2) opportunity-related qualities, or the possible common experiences or benefits provided by the activity setting that can be perceived or reasonably inferred through short term observation (Clark & Uzzell, 2002a).
The MEQAS-32 provides a comprehensive snapshot of the qualities of youth recreational and leisure activity settings, as observed at one point in time. In contrast to other assessments that measure the environmental qualities of specific types of physical environments, for example home or school settings, the MEQAS-32 can be used across contexts that vary in indoor vs. outdoor location, the type of activity taking place, the social nature of the setting, and the level of formality. The tool is intended to be a global, aggregate measure of pertinent place-based and opportunity-related qualities, that are captured based on short term observation, rather than a physical audit or detailed observational assessment of specific behaviours (King, Rigby et al., 2014). The MEQAS-32 can discriminate between different activity settings, and therefore, can be used to compare their features.
The MEQAS-32 can be applied to settings in which youth without and with disabilities (14 to 21 years of age) participate. The focus of the assessment is on the activity setting itself, rather than a specific youth or type of youth engaging in the activity. Since the MEQAS-32 captures objective ratings of generic environmental qualities, the tool is not designed to assess the ‘environmental fit’ for a specific youth participating in the activity setting. Rather, it is intended to provide a global snapshot of objectively-measured environmental qualities.
Clark, C., & Uzzell, D. L. (2002a). The affordances of the home, neighborhood, school and town centre for adolescents. Journal of Educational Psychology, 22, 95-108.
Heft, H., & Chawla, L. (2006). Children as agents in sustainable development: The ecology of competence. In C. Spencer & M. Blades (Eds.), Children and their environments: Learning, using and designing spaces (pp. 199-216). Cambridge, UK: Cambridge University Press.
King, G., Batorowicz, B., Rigby, P., McMain-Klein, M., Thompson, L., & Pinto M. (2014). Development of a measure to assess youth’s self-reported experiences of activity settings (SEAS). International Journal of Disability, Development and Education, 61(1), 44-66.
Rivera, H. H., Tharp, R. G., Youpa, D., Dalton, S., Guardino, G. M., & Lasky, S. (2005). Activity Setting Observation System Rule Book. Santa Cruz, CA: University of California at Santa Cruz.
Spencer, C., & Blades, M. (Eds.). (2006). Children and their environments: Learning, using and designing spaces. Cambridge, UK: Cambridge University Press.
7 Universal Design Principles
Equitable Use: The design is useful and marketable to people with diverse abilities.
Flexibility in Use: The design accommodates a wide range of individual preferences and abilities.
Simple and intuitive: Use of the design is easy to understand, regardless of the user's experience, knowledge, language skills, or current concentration level.
Perceptible information: The design communicates necessary information effectively to the user, regardless of ambient conditions or the user's sensory abilities.
Tolerance for error: The design minimizes hazards and the adverse consequences of accidental or unintended actions.
Low physical effort: The design can be used efficiently and comfortably and with a minimum of fatigue.
Size and space for approach and use: Appropriate size and space is provided for approach, reach, manipulation, and use regardless of user's body size, posture, or mobility.
NC State University, The Center for Universal Design (1997)
Job Site Analysis
A job site analysis allows the therapist and the worker to gain an understanding of the physical, cognitive, social and psychological demands of a job as well as workplace environment issues that may act as facilitators or barriers to return to work (Lysaght, 1997). Information regarding job demands can assist in developing targeted therapy goals. By comparing a worker’s current functional abilities and required job demands, work accommodations can also be proposed.
Ergonomic Assessment
Ergonomics, an applied science, can be defined as "the science of matching work environments to fit the physiological, psychological, and cognitive capabilities of the worker". Occupational therapists promote success in the workplace by improving the fit between the employee, the job tasks, and the environment. We work with employers and employees to adapt or modify the environment or task, facilitate successfulreturn to work after illness or injury, and help prevent illness or injury to promote participation, health, productivity, and satisfaction in the workplace.Essentially, in an ergonomic assessment, the occupational therapist is looking at fitting the job to the worker. It involves designing workstations, work processes, equipment and tools to fit the employee.
Driving Assessment
Occupational therapists assess the individual’s strengths and abilities related to the skill of driving. We then consider the context in which the individual is required to perform the occupation of driving.
Driving is a complex instrumental activity of daily living (IADL) that requires advanced skills in perception, analysis, and decision making on a continual basis, often without conscious effort (Dickerson, Reistetter, Davis, & Monahan, 2011; Mazer, Gelinas& Benoit, 2004).
Screening and assessment of skills related to driving is multifactorial with evaluation of psychomotor, cognitive and visuo-perceptual components providing information on impairments that may impact an individual’s ability to drive (Mazeret al., 2004; Vrkljan, McGrath & Letts, 2011).