Psychometrics of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults.

OBJECTIVE. To identify psychometric properties of the Home Safety Self-Assessment Tool (HSSAT) to prevent falls in community-dwelling older adults. METHOD. We tested content validity, test-retest reliability, interrater reliability, construct validity, convergent and discriminant validity, and responsiveness to change. RESULTS. The content validity index was .98, the intraclass correlation coefficient for test-retest reliability was .97, and the interrater reliability was .89. The difference on identified risk factors between the use and nonuse of the HSSAT was significant (p = .005). Convergent validity with the Centers for Disease Control and Prevention Home Safety Checklist was high (r = .65), and discriminant validity with fear of falling was very low (r = .10). The responsiveness to change was moderate (standardized response mean = 0.57). CONCLUSION. The HSSAT is a reliable and valid instrument to identify fall risks in a home environment, and the HSSAT booklet is effective as educational material leading to improvement in home safety.

Promoting school to work transition for students with emotional/behavioral disorders.

BACKGROUND: The successful transition of students from high school to adult occupations, including work and independent living, has been a major focus of the educational reform movement in the United States. However, despite good intentions, students with disabilities have less favorable transition outcomes than do students in the general population and employment opportunities are even less promising for students with emotional/behavioral disorders (EBD). OBJECTIVE: The purpose of this model demonstration project, funded by the US Department of Education, was to develop a program based on identified best practices to facilitate successful school to work transition for students with EBD. PARTICIPANTS: 47 students with EBD between the ages of 14 and 19 were participants in this project. The majority of participants in the project were white males with a generic diagnosis of a disruptive personality disorder. METHODS: Five cohort groups of students participated in a four phase program; Phase 1 - School-based Learning, Phase 2 - Community Involvement, Phase 3 - Paid, Supported Work Experience, and Phase 4 - Competitive Employment and Follow-Up. RESULTS: At the conclusion of the project, 30% of the project participants were competitively employed. Students had the most difficulty in Phase 3, but 81% of those who successfully completed Phase 3 obtained and retained competitive employment for a least one year. Four case studies are presented to illustrate findings. CONCLUSIONS: The School to Work Transition Program model shows promise for providing interventions to promote successful transition for students with EBD. Further research on the effectiveness of the overall model, as well as specific components of the model, is needed.

Systematic review of occupational therapy and mental health promotion, prevention, and intervention for children and youth.

We describe the results of a systematic review of the literature on children's mental health using a public health model consisting of three levels of mental health service: universal, targeted, and intensive. At the universal level, strong evidence exists for the effectiveness of occupation- and activity-based interventions in many areas, including programs that focus on social-emotional learning; schoolwide bullying prevention; and after-school, performing arts, and stress management activities. At the targeted level, strong evidence indicates that social and life skills programs are effective for children who are aggressive, have been rejected, and are teenage mothers. The evidence also is strong that children with intellectual impairments, developmental delays, and learning disabilities benefit from social skills programming and play, leisure, and recreational activities. Additionally, evidence of the effectiveness of social skills programs is strong for children requiring services at the intensive level (e.g., those with autism spectrum disorder, diagnosed mental illness, serious behavior disorders) to improve social behavior and self-management.

Occupational therapy community practice and home assessments: use of the home safety self-assessment tool (HSSAT) to support aging in place.

More than 70 million Americans are expected to be 65 years or older by 2030, with 8.7 million 85 or older. Occupational therapists can provide client and population-centered interventions to promote home safety, functional abilities, and quality of life to support older adults' desires for independence and to age in place. This includes the use of assistive technology, home modifications, and rehabilitation principles, to design real life solutions to support the needs of older adults. Using case study methodology this paper focuses on the development and pilot-testing of the Home Safety Self-Assessment Tool (HSSAT), a new home assessment, designed for use by older individuals to promote home safety and aging in place. The results suggest the tool may assist older adults in identifying environmental factors that are related to falls and facilitate their ability to age in place.

Measuring usability of assistive technology from a multicontextual perspective: the case of power wheelchairs.

Assistive technology (AT) devices enable people with disabilities to function in multiple contexts and activities. The usability of such devices is fundamentally indicative of the user's level of participation in multiple roles and occupations. Seventy people who used power wheelchairs were interviewed using a novel tool, the Usability Scale for Assistive Technology (USAT). The USAT uses a human factors science framework to investigate the wheelchair user's perceived independence in mobility-related activities within home, workplace, community, and outdoors in accordance with the characteristics of the wheelchair, environmental factors, and abilities and skills of the user to operate the wheelchair. Descriptive analysis of the data revealed usability issues with the use of power wheelchairs in all contexts. Users confronted far more significant issues within the community and outdoor environment compared with those at home and in the workplace. These issues have been elucidated and applied to an intervention framework with relevance to a multitude of AT stakeholders.

Conceptualization and measurement of assistive technology usability.

UNLABELLED: The concept of product usability has been discussed in several areas of product research and development. Usability, within the realm of assistive technology (AT) devices, determines how effectively and efficiently AT users with disabilities can function in different contexts and environments. OBJECTIVE: This article conceptualizes and proposes the significance of AT usability and its measurement in entirety from a human factors perspective. Conceptual models that characterize the interaction of the AT user, the AT device, the context and the involved activity is considered to be the hallmark of measurement of AT usability. On that basis, the article highlights the methodology and the initial progress of the development of an AT outcome tool, the Usability Scale for Assistive Technology (USAT), to measure self reported degree of AT usability. METHODOLOGY: In order to identify usability indicators for measurement, a qualitative study was conducted by exploring the experiences of AT users. Ten participants who used either wheeled mobility or computer based AT devices were interviewed with questions based on the theme of a usability framework. RESULTS: The coded interview data generated more than 800 usability indicators specific to the two categories of AT devices. These indicators were mapped to a generic usability criteria list for construction of the USAT-Wheeled Mobility and the USAT-Computer Access. IMPLICATIONS: The USAT, when developed, is projected to be valid and useful for AT outcomes research as well as clinical practice. The use of the USAT will enable researchers and clinicians to comprehensively identify factors that underlie effectiveness and efficiency in AT device use and establish intervention protocols to optimize user-AT interaction.

The development of the School Function Assessment Chinese version for cross-cultural use in Taiwan.

The primary purpose of this research project was to translate and adapt the School Function Assessment (SFA), a standardized criterion-referenced instrument that measures school-related functional skills, for its cross-cultural use in Taiwan. The project consisted of four study phases: translation, cultural adaptation, pilot testing, and field testing for standardization. A series of rigorous procedures including the method of translation and back-translation, team consensus for cultural adaptation, and Rasch modelling techniques were used to address various dimensions of cross-cultural equivalence and psychometric properties of the translated SFA. The protocols that were developed as well as technical issues that were addressed in this project provide useful guidelines for international occupational therapists who are interested in translating and adapting instruments for cross-cultural use.

The international classification of functioning, disability and health and its application to cognitive disorders.

PURPOSE: This paper describes the conceptual foundation and systematic framework of the International Classification of Functioning, Disability, and Health (ICF) as a mechanism for understanding the course and consequences of various health related states. The specific application of the ICF with persons with cognitive dysfunction is also presented. METHOD: A comprehensive literature review related to the conceptualization of the ICF, its classification scheme and coding process is presented. Information on cognitive disorders including prevalence, functional manifestations and the assessment of a person's cognitive functioning and the applicability of the ICF's holistic classification and coding of cognitive dysfunction within the components of body structure and function, activity and participation, and environmental attributes is also reviewed. CONCLUSION: The ICF has the potential to classify and interpret cognitive deficits on a global level and thereby reflects upon the overall health and functioning of the individual in major life activities. The coding system systematically organizes measures related to the person's cognitive status and the resulting functional outcomes. The ICF focuses on individuals' performance of activities in all aspects of life and validates the independence and well-being of persons with disabilities making it an important instrument to be used by rehabilitation professionals.

Collaboration between team members in inclusive educational settings.

SUMMARY The inclusion of students with disabilities into general education settings and programs has necessitated the development of integrated, collaborative service delivery models that are compatible with the goals and purpose of inclusive education. Although there is considerable theoretical literature on collaboration, there is minimal empirical data available on the process or its outcomes. The purpose of this exploratory study was to gain insight on the perspectives of regular and special educators, and occupational, physical, and speech-language therapists towards collaboration. Using a semi-structured interview, participants (n = 51) responded to questions concerning the definition, nature, and extent of collaboration in their school setting. Participants also responded to questions related to the advantages of, barriers towards, and strategies to promote collaboration. Participants typically defined collaboration as not a problem-solving process, but in terms of activities associated with it. Results indicate that participants believed collaboration was mutually beneficial for both students and team members. However, implementing a collaborative approach was problematic. Lack of administrative approval for time for planning meetings was the most frequently cited barrier to collaboration. Although 51.6% of the participants reported time available for collaborative planning by regular and special educators, only 21.5% of the participants reported this time being available for therapists to meet with educators. Education about collaboration, either in professional/preservice education programs or as continuing education, was recommended as a strategy to facilitate a collaborative approach. Although a collaborative approach is being used by therapists and educators more and more frequently, there is a need for research to validate its efficacy.