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The PEO Model of Occupational Performance and Universal Design.

The Person-Environment-Occupation (PEO) Model of Occupational Performance comes from the field of occupational therapy and helps identify the relationships between a person, an environment, and occupations (activities). These relationships support and enhance a person’s ability (Law et al, 1996); interestingly, that’s what universal design is all about.

The relationship between each helps us understand the quality of occupational performance (i.e., function) that results at the intersection of each component of the PEO. Our goal in every universal design process should be to maximize the “fit” between each component, which will optimize the functionality for all intended users.

The PEO shows us why universal design is difficult

Consider the definition of universal design:

Design that’s usable by all people, to the greatest extent possible, without the need for adaptation or specialized design.

Ron Mace, 1985

“Design” in this conversation is primarily the “environment” part of the PEO Model. If there’s a desire to create a design that provides optimal function for all people, it’s critical to have a deep understanding of all intended users (including all people affected by disability) and all the different ways those users can interact with a design. Without that knowledge, it won’t be possible to identify potential barriers to usability.

This is REALLY difficult, especially because we each have different biases and understandings of how disability affects people. If bias gets foothold in the universal design process, it will result in some degree of exclusion.

The environment’s role in disability

The World Health Organization (WHO) suggests that disability results from mismatched interactions between features of a person’s body and features of the society in which he or she lives.

Consider the area of intersection between the circles in the Person-Environment-Occupation Model. If the environment is designed to be a good “fit” for all intended users (persons) and the activities (occupations) intended to be performed, then we can say that the design ENABLES people.

On the flip side, if there’s a poor Person-Environment-Occupation fit, then we can say that the design DISABLES people. We ought to take the following statement by the WHO seriously when designing things.

“Overcoming the difficulties faced by people with disabilities requires interventions to remove environmental and social barriers.” (source)

Let’s not exclude people because of health problems that can’t be changed. The way things are designed can be changed. That’s what we need to focus on. Have you seen the video of Zach Anner and his quest to get a rainbow bagel? This is well worth 7 minutes of your time:

Zach experiences different types of environmental barriers. Some are physical, and some are attitudinal. Sure, he makes it look funny, but you can see how the environment plays a significant role in successfully completing tasks (occupations) that typically-abled folks wouldn’t think twice about.

An hour to get outside of his hotel? RIDICULOUS. Anyway…

How the PEO helps us design homes universally

Our homes have a direct impact on how well we can live our lives, care for ourselves, care for our family, and more. When someone isn’t able to take care of their own daily needs (e.g., bathing, dressing, cooking, cleaning, etc.) because they’re unable to easily use their home, external support is often necessary. This can be a major frustration for the individual, and an extra stressor for anyone assisting. Roles and routines, such as taking care of children and/or pets, are important to many people too. The design of the places we live is often the factor that enables us to successfully do the things that are most important to us.

When designing a home for universal access, the Person-Environment-Occupation model helps us slow down and consider all possible users of the home. We want to accurately be able to say “this home is designed for people of all ages and abilities.” To do that, we have to not only recognize who “people of all ages and abilities” includes, but we have to think about all the typical activities (occupations) that “people of all ages and abilities” do in a typical home environment. The PEO Model will help designers quickly realize that there’s a whole lot more that goes into a universally designed home than a no-step entry, wide doorways, and lever door handles.

As an occupational therapist, I can’t tell you how many stories I heard of people just “getting by” in their homes. One couple talked about making a reservation in a hotel every few weeks for her husband to get a real shower because the only bathroom in their house was on the second floor. One gentleman wasn’t able to continue his love for woodworking because it was too much effort to walk down to the basement. Over and over I’ve seen people struggle because of design issues. This needs to change.

The design of our homes needs to support the abilities of people in our communities. Is this really too much to ask?

While it’s great that businesses have been working to help improve the safety and functionality of people in their homes, the market is largely focused on remodeling to address what needs to be fixed, not changing the way homes are designed from the beginning.

How the PEO helps us design programs universally

Similarly to the design process of homes, the PEO Model is incredibly useful for program design. If we want to accurately be able to say “this program is designed for people of all ages and abilities,” that means we not only have to be able to identify the full diversity of who we want to be able to participate, but the different methods those people may utilize to participate. Without this knowledge, it will be difficult to successfully accommodate some people and create a welcoming program environment.

It’s common knowledge that physical activity is good for one’s health, but there are less obvious benefits to participating in an activity alongside others, especially for individuals with disabilities. These can include the development of friendships, increased self-image via acceptance into community, increased self-esteem, greater self-sufficiency, decreased negative stereotypes, and more (Anderson & Kress, 2003; Schleien & Green, 1992; Snow, 2013b). Furthermore, the social benefits of recreation may be more impactful than the physical or psychological benefits (Anderson & Heyne, 2012).

Understanding the benefits to social participation is important, if for no other reason than to acknowledge that there’s just as much of a need for opportunities for people affected by disability as there is for our typically-abled neighbors. Active engagement in activity can play an important role in improving quality of life, especially when people feel welcomed and included in the program in which they are participating (Anderson & Kress, 2003). The challenge is to design activities that facilitate this level of social inclusion for people affected by disability.

Can people do universal design without the PEO?

At the time of this writing, there is no “standard” universal design process. There’s no requirement to use any model like the PEO. The only way to gauge whether universal design has been executed successfully is to determine if anyone is excluded from using a design.

The PEO Model is useful because it forces us to look beyond design features and characteristics. When we truly understand the functional diversity of the people who may benefit from a design, in addition to the variety of ways those people can use and interact with a design, and those variables influence the design itself, only then will we be able to ensure that what we create will be welcoming to people affected by disability.

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