ICF Ecological Receptivity Health Condition ( disorder/disease ) - - PDF document

SLIDE 1

1

Measuring the Environment

The Community Health Environment Checklist presented to ICF 運用國際研討會 August 2013

Susy Stark, PhD, OTR

Contributors:

David Gray, Ph.D. Holly Hollingsworth, Ph.D. Kerri Morgan, MS OTR/L Susan Stark, Ph.D. Jess Davinroy, OTD

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

y, Jeff Cuthbert, MSOT Trish Welch-Saleeby, MSW Dana Sutter MSOT, OTR/L Mike Scheller, RPT OT Doctoral students OT Masters degree students

• 19 million people (10% between 16 and 64) in the U.S. have a

disability (American Community Survey, 2011)

• People with disabilities encounter barriers in society (physical

and attitudinal) (Gray and Hahn, 1997)

Introduction

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Barriers decrease participation in community and quality of life

(Stark, Hollingsworth, Morgan, & Gray, 2007)

Transactional Approaches of Conceptualizing Person-Environment Fit

►The success of a persons participation in a given setting is not dependent on a simple property of either the

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

is not dependent on a simple property of either the person or their environment, it is a product of the two (Lewin, 1951)

Ecological Receptivity

►Ecological Receptivity refers to the transactional relationship between the features of the community environment and the attributes of individuals with di biliti th t i fl hi h ti i ti i

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

disabilities that influence his or her participation in community. ►The features of community environments include the political, economic, physical and social characteristics.

Health Condition

(disorder/disease)

ICF

Body function & Activities Participation

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

Environmental Factors Personal Factors y structure (Impairment) (Limitation) p (Restriction) WHO, 2001

SLIDE 2

2

Reasons for Developing the Community Health Environment Checklists (CHEC)

• By identifying barriers and supports in the community

environment, we can identify features that influence the participation of people with disabilities

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• We wanted to focus on those features of most

relevance to people with disabilities who have a mobility, hearing or visual impairment

Purpose of the CHEC

• The purpose of the CHEC is to provide an objective

measure of the physical and social environment, including the features important to persons with disabilities

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• The CHEC is a valid and reliable measure of

environmental accessibility and receptivity

• Scored dichotomously (Yes & N/A = 1 No = 0)

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

CHEC Development Procedures

• Review existing literature on assessing receptivity
• Methods
• Key Informant Interviews
• Focus Groups
• Cognitive Mapping

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Survey Draft
• Feature Ranking by Individuals with Disabilities
• Identifies Most Important Features
• Development of Scoring
• Interclass Correlations
• Brief Training for Raters

Problem Statement

►Problem Statement

• Community environments are not designed to meet the needs of people

with disabilities.

• Social participation is impacted by how people are able to use their

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Social participation is impacted by how people are able to use their

environments.

►Purpose

• By identifying barriers and supports in the community environment,

domains influencing social participation will be identified.

Research Question

►Research Question

• What are the characteristics or features of an environment that make it

more or less receptive to people with mobility impairments?

• Where do active community members with disabilities go?

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Where do active community members with disabilities go?

►Approach

• Cognitive mapping identifies a person’s perception of their environment.

SLIDE 3

3

Cognitive Maps

►Means to represent perception of environment

• Images and beliefs
• Paths of travel and facilities used

(Lynch,1960)

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

*people with disabilities behave differently based

• n barriers and supports in the community

(Vujakovic and Matthews. 1994)

Design and Procedure

►Design

• Qualitative
• In home interviews
• Cognitive mapping

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Cognitive mapping

exercise

• Member check (focus

groups)

►Analysis

• Constant comparative

method

Participation, Environment and Performance Laboratory, Program in Occupational Therapy Participation, Environment and Performance Laboratory, Program in Occupational Therapy

Participants

►Inclusion Criteria

• Presence of a mobility

limitation R id d i S L i

►Demographics

• 25 people with mobility

limitations M 46 9

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Resided in St. Louis

metropolitan area

• Left home 2‐3x/ week
• Mean age= 46.9 yrs.
• 14 female/ 11 male
• 13 Caucasian/ 10 African

American

• stroke, SCI, CP, & post polio

Findings: 22 Key Features

►Distances to Enter Building Accessible Parking ►Level Surfaces ►Curb Cuts ►Doors at Entrances ►Signage for Accessible Paths to

• Crowding
• Floor Surfaces
• Counters and

Merchandise

• Accessible Places to Sit

Ad Li h i

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

►Signage for Accessible Paths to Entrances ►Doors Inside the Building ►Loaner Scooters or Wheelchairs ►Signage for Accessible Elements ►Single Level ►Maneuverable Spaces

• Adequate Lighting
• Accessible Restroom
• Drinking Fountain
• Accessible Phone
• Drive‐through Window
• Usability
• Rescue Assistance

SLIDE 4

4

Findings: 15 Key Destinations

►Government Buildings ►Major Tourist Destinations ►Transportation ►Health Care Providers ►Health Vendors ► f l

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

►Performance Venues ►Large Stores ►Small Stores ►Self Care Service Providers ►Dining Establishments ►Professional Service Providers ►Indoor Leisure ►Outdoor Leisure ►Religious Facilities ►Schools and Libraries

Discussion

►Receptivity is a blend of physical, social, and policy features of an environment ►People with mobility impairments do identify features of the environment that

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

y increases/decreases receptivity. ►These features and characteristics are not adequately represented in existing measures

CHEC Development Goal of Study

►The goal of this study was to produce a concise instrument that would determine if a building’s physical features were ecologically valid from the perspective of individuals with

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

p p mobility impairments and could predict their community participation. ►Used easily by quasi‐professionals (free of jargon)

►Theoretical guidance and interview data have contributed to the development of an evaluation procedure that will capture receptivity more precisely in the community environment

Instrument development

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

y ►Developed to be used in 15 the destinations categories identified by respondents ►Evaluates the 22 features of the destinations identified by the respondents

Review by consultants

►Consultants suggestions:

• Scaling (to weight items)
• Make the form “user friendly” and not

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

technical

• Make a “rule book” instead of a complicated

scoring sheet

SLIDE 5

5

The CHEC

► Major sections:

• Entering building
• Using the Building
• Using restrooms
• Amenities

► Features

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

► ea u es

• 22 Features
• Captured the essence of the

participant’s comments

► Items

• Individual questions that capture

the presence of the feature

• Scored dichotomously (yes &

N/A = 1 No = 0)

Flexibility of the CHEC

►Receptivity can be characterized at the Community Level

• Total CHEC Scores on a sample of destinations

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Receptivity of “ accessible restrooms” of entire

community (features by destination)

►Receptivity can be characterized at the Destination Level

• Total CHEC score of the destination or Area of a

building (this building)

• Receptivity of features (seating)

Sampling Strategy

►Identify the boundaries of a community

• Political
• Geographic
• Identified by population of individuals with disabilities

►Identify all possible destinations within the community within

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

y p y each destination category ►Sample 10% of the destinations within each destination category ►If a “community” does not contain a destination within a category (e.g. hospital), use the closest destination of that type to the center of the community and rate that destination

University City, MO

Red: City Hall Green: CHEC Sites

Red: City Hall Green: CHEC Sites Blue: Reported destinations visited by people with ml Yellow: Overlap Yellow: Overlap

Participation, Environment and Performance Laboratory, Program in Occupational Therapy Jeff Cuthbert, OTR cuthbertj@msnotes.wustl.edu

Rule Book and Glossary

►Available to provide assistance in determining score ►Resources on which rules are based:

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Based on the important descriptions of the experts (people with

mobility limitations)

• Consultants (experts in architecture, universal design, occupational

therapy)

• Literature and standards

The RULE BOOK

► “can you get in, do what you

need to do and get out without much difficulty” ►Determine if “one” accessible feature is present and evaluate that feature (e.g. th ibl b th )

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

the accessible bathroom) (versus all features)

► Column 1 and 2 are the same as the CHEC ► The third column contains the rules for the corresponding item.

SLIDE 6

6

The GLOSSARY

► Items that are more difficult or involve measurements have a visual picture for clarification. ► Glossary items are numbered and arranged in alphabetical

• rder

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• rder.

► Links to the glossary can be found on the corresponding item in the CHEC

The GLOSSARY

► Items that are more difficult or involve measurements have a visual picture for clarification. ► Glossary items are numbered and arranged in alphabetical

• rder

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• rder.

► Links to the glossary can be found on the corresponding item in the CHEC

In the field

►Evaluations are completed during “busy time” ►Time

• 5 minutes small

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• 5 minutes small

building

• 90 minutes large

building

►1‐2 raters ►Using paper/pencil, PDA, or Tablet PC

Scaling and Scoring

►Scored dichotomously (yes & N/A = 1 No = 0) ►22 Features weighted based on ranking of “importance” of items ►Ranking Study

• 17 of the original subjects

(78 different rankings by destination category)

• Ranked each feature based
• n directions “imagine the

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

importance of items (based on ranking study) ►Weights were transformed monotonically to yield the range of a destination score to be from 0 to 100

• n directions imagine the

most accessible place for you… “

Features & Weights

Entrance 9.62 Curb Cuts 8.65 Automatic Doors 8.65 Accessible Bathroom 8.65 Elevator/ Single Level 6 73 Spaces not Crowded 3.85 Accessible places to sit 3.85 Accessible path/ entrance marked 2.88 Accessibility Signage 2.88 A ibl C t 2 88

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

Elevator/ Single Level 6.73 Distance to Entrance 5.77 Accessibility features in order 5.77 Wide Spaces 5.77 Floor Surfaces 4.81 Lightweight Doors 4.81 Parking 4.81 Accessible Counters 2.88 Lighting 1.92 Accessible Phone 1.92 Accessible Drinking Fountains 1.92 Area of Rescue 1.92 Loaner Wheelchair/ Scooter 0.96 Drive Through Window 0.96 Site:

XYX building

Section I Yes Notes Score ENTER BUILDING

Accessible parking Are there accessible parking spaces with adequate widths and aisles for a person with a mobility device to

EXAMPLE: CHEC Page 2

SECTION FEATURE

Participation, Environment and Performance Laboratory, Program in Occupational Therapy a pe so w t a

• b

ty dev ce to get in and out of their car? Are the accessible spaces located closest (or most central) to the accessible entrance or accessible route with minimal traffic to cross in order to enter the building? 1 Does the facility have an enforcement procedure to ensure that accessible parking is used by

• nly those who need it?

1

Subtotal

2 3.2

3.2 = 2*4.81/ 3 2 of 3 Yes’s & Weight 4.81

SLIDE 7

7

Scoring

►Scores are computed for each Feature within each Section. ►A Section score is the sum of the Feature

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

scores. ►The total Destination score is the sum of the Section scores. ►NB: The scoring has been scaled such that the highest Destination score is 100.

Data Analyses

►Software:

• Data Entry – MS Access
• Analysis ‐ SPSS or SAS

►Analyses:

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

►Analyses:

• Destinations & Features

►Descriptive Statistics ►Reliability & Validity ►Destination ‘Report Card’

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

Validation - Urban

►University City Missouri

• Urban Environment

►63 destinations rated

• 1,500 sq ft – 20,000 sq ft

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

1,500 sq ft 20,000 sq ft (10‐90 minutes)

►CHEC score 4.2 (poor)‐ 97.2 (excellent) receptivity ►Cronbach’s alpha .95

Validation - Rural

►Menomenee

• Rural environment

►45 destinations rated

• 2000 sq ft – 20,000

sq ft (3 27

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

sq ft (3 - 27 minutes) ►CHEC score 21.2 (low)- 100.0 (excellent) receptivity ►Cronbach’s alpha .92

CHEC: Environmental Feature Scores

10 20 30 40 50 60 70 80 90 100

Compliance

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

S p a c e s n

• t

C r

• w

d e d E l e v a t

• r

/ S i n g l e L e v e l L

• a

n e r W h e e l c h a i r / S c

• t

e r C u r b C u t s L i g h t i n g F l

• r

S u r f a c e s L i g h t w e i g h t D

• r

s A u t

• m

a t i c D

• r

s A c c e s s i b l e D r i n k i n g F

• u

n t a i n s A c c e s s i b l e P h

• n

e A c c e s s i b l e p l a c e s t

• s

i t D i s t a n c e t

• E

n t r a n c e A c c e s s i b l i t y f e a t u r e s i n

• r

d e r E n t r a n c e W i d e S p a c e s A c c e s s i b l e p a t h / e n t a n c e m a r k e d A c c e s s i b i l t y S i g n a g e A c c e s s i b l e B a t h r

• m

A r e a

• f

R e s c u e A c c e s s i b l e C

• u

n t e r s P a r k i n g Features for All Sites

SLIDE 8

8

Rural vs Urban

P=.08 Group Statistics 58 30.4929 7.04734 .92536 43 32.8116 6.18793 .94365 50 29.9647 6.08400 .86041 City University City, Menomonie, W University City, Section I Entering Destination Section II Using t N Mean Std. Deviation

• Std. Error

Mean

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

P<.01 P=.12 P<.01 P<.01 50 29.9647 6.08400 .86041 40 33.5537 5.42382 .85758 62 4.5797 4.00905 .50915 45 5.7179 3.46479 .51650 55 8.7850 3.54315 .47776 45 10.6410 2.94517 .43904 59 72.8493 15.62835 2.03464 45 81.7977 15.34053 2.28683 y y, Menomonie, W University City, Menomonie, W University City, Menomonie, W University City, Menomonie, W g Destination Section III Restro Section IV Ameni Destination

►Section I Entering the Building 0 72

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

►Section I Entering the Building 0.72 ►Section II Using the Building 0.95 ►Section III Restrooms 0.87 ►Section IV Amenities 0.86

Limitations in flexibility

►Difficult to translate to different cultures

• Transportation differences

►Only developed for persons with mobility limitations – small sample size

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

small sample size ►Value not in the final items but in the approach and method

• Groups interested in vision/hearing may want a version
• International partners may wish to develop a version

Why use this measure?

►Assesses the receptivity of the physical environment from the perspective of persons with mobility impairments

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

►Is brief, intuitive, and easy to administer ►Excellent internal consistency ►Internal validity ICF Codes

I CF EF Codes E-Codes Description Total Second Level Codes CHEC E 110 to 199 Products & Technology 14 4

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

E 210 to 299 Natural Environment & Human-made Changes to Environment 13 3 E 310 to 399 Support & Relationships 13 7 E 410 to 499 Attitudes 14 8 E 510 to 599 Services, Systems & Policies 20 12

CHEC low vision; hard of hearing Gray et al.

SLIDE 9

9

Existing CHEC Instruments

Mobility Low Vision Hard of Hearing

General Building (GB) General Building (GB) General Building (GB) Restaurants Restaurants Restaurants

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

Doctors’ Offices (DO) Exercise Facilities Houses of Worship Doctors’ Offices (DO) Doctors’ Offices (DO) Parks

CHEC CHEC-

• Low Vision Feature Ranks

Low Vision Feature Ranks

• 1. Glare‐reducing features
• 2. Materials in alternative formats
• 3. Adequate exterior lighting
• 4. Adequate task lighting

5 Clearly marked interior stairs/ramps

• 10. Adequate ambient lighting
• 11. Clear/Smooth pathways for

interior walking

• 12. High environmental contrast
• 13. Clearly‐marked wayfinding signs

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

5.Clearly‐marked interior stairs/ramps with handrails for support 6.Clearly‐marked signs

• 7. Clear smooth pathways for outdoor

walking

• 8. Accessible crosswalks
• 9. Clearly‐marked exterior stairs/ramps

with handrails for support y y g g

• 14. Employee assistance
• 15. Accessible elevators
• 16. Accessible entrance
• 17. Painted curbs
• 18. Special seating

CHEC-Hard Of Hearing Feature Rank

1 . Low background noise 2 . Captioning 3 . Seating arrangem ent ( near w alls or near speaker) 4 . AT ( listening devices/ video phones/ capTel phones/ m icrophones) 5 . Em ployees w ho speak slow ly and clearly 1 1 . Adequate lighting 1 2 . Proxim ity to em ployee for lip reading 1 3 . Assistance from stranger/ em ployee/ co-w orker to locate item or repeat m essages 1 4 . Training on use of assistive technology

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

and clearly 6 . Minim al crow d 7 . Seating type ( sm all or round tables, booths) 8 . Text or visual aids ( signage/ posters/ m onitors) accom panying oral m essages 9 . Low background m usic 1 0 . Acoustics ( sound absorbing w all and floor covering) technology 1 5 . Provision of pagers or buzzers ( restaurants) 1 6 . Access to alternative room 1 7 . Alternative com m unication ( pen and paper) 1 8 . Self check-out 1 9 . Suggestions box 2 0 . I nterpreter

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

CHEC CHEC-

• ING OUT MISSOURI

ING OUT MISSOURI

Preliminary Analysis

90 100

Mean general building score by community

e (scale 0 to 100%)

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

70 80 Cape G Farmington Hannibal Poplar Bluff Rolla Warrensburg Mobility Vision Hearing

Accessibility score

How accessible are sites in my community for individuals with mobility impairments?

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

SLIDE 10

10

Which Health Vendor is most accessible for my client with low vision?

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

How does my Grocery Store compare to the others in Town?

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

What are the accessibility issues of a particular clinic?

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

If you have questions…….

• Susy Stark, PhD, OTR/L

starks@wusm.wustl.edu

• Jessica Dashner, OTD OTR/L

dashnerj@wusm.wustl.edu

Participation, Environment and Performance Laboratory, Program in Occupational Therapy

• Visit:

www.disabilitycommunityparticipation.org