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
Agenda
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Introduction
Overview of accessibility and universal design
Residential spaces
Public spaces
Information accessibility
Learning and education accessibility
Product accessibility
Wrap-up
Residential Assessments
Approach
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Context of evaluation provision
Degree of client – centeredness
Degree of PEO
Skills of therapist/evaluator
Range of tools
– Availability
Acute Care
Rehabilitation
Home Health Care
Home Mod Specialist
AARP
COUGAR
SAFER-HOME
HEAP
I-HOPE
WESTMEADE
CASPAR
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. http://www.aarp.org/home-garden/livable-communities/info-07-2011/make-your-home-a-safe-home.html
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 4point (0-3) scale
Chiu, T., & Oliver, R. (2006). Factor analysis and construct validity of the SAFER-HOME. OTJR: Occupation,
Participation & Health, 26(4), 132-142.
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
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,
580-589. doi: 10.5014/ajot.2010.08065
I - HOPE
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),
171-179.
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), 124-130.
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), 43-55.
References for residential tools
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AARP. http://www.aarp.org/home-garden/livable-communities/info-07-2011/make-your-home-a-safehome.html
Chiu, T., & Oliver, R. (2006). Factor analysis and construct validity of the SAFER-HOME. OTJR:
Occupation, Participation & Health, 26(4), 132-142.
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),
171-179.
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), 124-130.
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, 5971
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), 43-55.
Stark, S. L., Somerville, E. K., & Morris, J. C. (2010). In-home occupational performance evaluation (IHOPE). American Journal of Occupational Therapy, 64, 580-589. doi: 10.5014/ajot.2010.08065