Using design and construction knowledge to develop an

Using design and construction knowledge to develop an occupation-focused process for home modifications Rachel Russell MSc SURFACE University of Salford

What role does OT have in Design and Construction of the built environment? “Design is an active, purposeful adaptation method that people use to adjust their world to their needs. Through design, humans both remove barriers and develop supportive environments, products, and systems to facilitate achievement of their goals” Steinfield & Maisel 2012

Unique perspective of the Built Environment through the lens of Occupation: Ecologist of the health professionals: The built environment shapes our occupations and occupational performance and our occupations and occupational performance shapes the built environment… Occupational environmentalists!!!!!

They see…

But through the lens of Occupation, we see. . Leisure Ritual/habits Personal Care Task Cultural Play Developmental Domestic Tasks/Roles Design and construction can be used to enhance, restore, acquire, or prevent the loss of occupational performance skills

…start of my Ph. D journey

But first I had to understand the process! • On-line questionnaire • Mix of open and closed questions • 135 respondents

Key findings Which theoretical model influences your practice My practice is not influence by a specific model of occupational therapy 58% Other Model 6% Canadian Model of Occupation Performance 12% Occupational Performance Model: Australia 2% Person Environment Occupation Performance Model 6% Person Environment Occupation Model 11% KAWA Model 2% Model of Human Occupation 4% 0% 10% 20% 30% 40% 50% 60%

Use of Assessment Tools 2% I routinely use a standardised assessment tool as part of the process of designing housing modifications 51% 47% I routinely use a departmental designed assessment tool as part of the process of designing housing modification I do not routinely use an assessment tool as part of the process of designing housing modification

Why modification goes wrong! Rarely get a complaint 5% The modification did not meet the users/clients needs 10% I rarely get feedback after I am involved in a bathroom modification 11% My recommendations/specification were not followed by other professional involved in the process The modification was not what the user/carer was expecting The look/aesthetics of the modification Specifications were not followed by the builder The workmanship 16% 19% 43% 53% 63% 0% 10%20%30%40%50%60%70%80%90%100%

How do you discuss the design of the modification with the person 84% Give a verbal description of the modification 79% Show them catalogue pictures of products Show them pictures/photographs of other housing modifications 67% Joint visit with a design/constuction professional to give information 50% Show a 2 D CAD drawings 50% Take them to look at a completed bathroom modification (i. e. to a Disability Living Centre) This is done by another professional/agency Show a 3 D CAD drawing 17% 13% 8%

What do you want to improve with the process you use? Theme To be able to analyse the proposed modification will meet the individuals requirements more effectively To be able to access up to date product specification or information when planning a bathroom modification To give the individual a better visual idea of what the modification will look like when completed To have access to better assessment tools for collecting information Use of CAD and other information technology to improve process Improve collaboration with other professionals Time Financial Resources

Supported the evidence on issues with the process used by OTs – Need to explore fully our client requirements during the design process (Fange & Iwarrson 2005) – Tend to focus on a narrow definitions of Person, Environment, Occupation fit parameters (Hocking 1999 and Heywood 2004) – Lack the ability to effectively analyse how our recommendations will perform and support occupational performance (Palmon 2004, Bridges 2006) – Fail to adopt a collaborative approach. When we do collaborate the individual finds it confusing (Nord et al 2009) – Explore the use of 3 D CAD analysis tools when planning and evaluating housing modifications (Eriksson 1996)

Outcome of the 1 st phase of the research: Need for an “occupation-focused” design and construction process for home modification (Fisher 2009/2013)

How the Design and Construction Industry can help: • Similar issues to OTs • Design and construction industry researchers recognise how complex the process is • Developed a number of standardised processes to help manage their practice. • Collect the right information, at the right time, and to use the information to design and construct buildings that meet the needs of those occupying them.

Developing the Process Questionnaire Data The Occupational Therapy Intervention Process Model (Fisher 2009) Generic Design and Construction Process Protocol (Cooper et al 2000) Process Protocol Home Modifications

OTIPM Fisher (2009/2013)

OTIPM Fisher (2013)

Generic Design and Construction Process Protocol (Cooper et al 2000)

Process Protocol for Home Modification © 2013 Rachel Russell. All rights reserved

© 2013 Rachel Russell. All rights reserved

© 2013 Rachel Russell. All rights reserved

© 2013 Rachel Russell. All rights reserved

Part 2: Trying the Process Protocol out with a team of Housing OT’s Proof of concept approach: • Identified why the team wanted to use the Process Protocol • Mapped the existing process • Identified what the team needed to do to implement the Process Protocol • Implemented the changes • March 2014 – September 2014

What the team were wanting to achieve • Occupation-focused • Encourage consistency of practice amongst the team • Understand how the OT process fits within the existing housing adaptations process • Promote the role of OT in the Housing Team • Understand the role of OT in the design and construction process

The Existing process mapped onto the Process Protocol for Home Mods

Feedback from the proof of concept: • It was helpful to have clear stages and a step-by-step guide to the home modification process, as we realised that we had a tendency to cram multiple stages into one visit • The protocol focusses us on each different step in the process, making sure that nothing is left out and that the client is consulted at every stage • We have developed a product information sheet for use with clients as a result of this • Examine our current practice, and how we fit within our wider team and with other services • Illustrate our role to colleagues in other professions, and explain our involvement in the major adaptation process • Use as an induction tool with new OT staff

What I’ve learnt so far… The intervention is not this…

What I’ve learnt… …it is this! © 2013 Rachel Russell. All rights reserved

Thank you • Rachel Russell • @bronteot • r. russell@edu. salford. ac. uk