008: Research about interprofessional design

We discuss 3 themes from a peer-reviewed article: form versus function, the earlier the better, and universal design as a specialist area.

008: Research about interprofessional design
Good Fit Poor Fit

 
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Show notes

The article we discuss in this episode is “Community Mobility in the Context of Universal Design: Interprofessional Collaboration and Education” by Danielle Hitch, Helen Larkin, Valerie Watchorn, and Susan Ang.

You can find a PDF copy by searching Google Scholar.

Transcript

[00:00:30] Hey, it’s Sarah, and today I have Kati Richardson with me and we are going to chat about a research article that helped confirm through research some of the difficulties we were having with our original consulting business. If you don’t know our business story, Scott and I originally started a consulting business in 2012 in which I as an OT would go into people’s homes and give recommendations on how to make areas of the home more functional for people by suggesting changes.

[00:00:58] Some of these changes could be as simple as widening a door or constructing a ramp, but others were along the lines of renovations that needed to make the space more functional for the homeowner. I, of course, didn’t have construction skills and needed to have the help of a licensed builder or architect to make those changes.

[00:01:18] We ran into a lot of barriers, but professionally, many did not understand why an OT would be involved and how the collaboration process should work. In fact, we found that there wasn’t really a set collaboration process out there to follow. 

[00:01:33] When we found this article, we felt like our struggles and the barriers we were seeing in our practice had been put into words and it was a plus because it was actual research.

[00:01:43] Yet, the barriers to consulting were enough that we decided we needed to change the direction of our business to make it work. Currently, we are a nonprofit and work collaboratively on designs within our organization. 

[00:01:57] Next, Kati’s going to share a bit about this article.

Kati: [00:02:00] Thanks, Sarah. So the title of the article is Community Mobility in the Context of Universal Design: Interprofessional Collaboration and Education written by Hitch, Larkin, Watchhorn, and Ang. This article was published in the Australian Occupational Therapy Journal in 2012.

[00:02:20] Let’s quickly review some highlights. It focuses on the needs and practices of both occupational therapy and architecture in universal design and concluded that each profession has its own strengths and skills to bring to the design process.

Form versus Function

[00:02:34] Now let’s discuss the three main themes. The first theme is Form versus Function. This means that the architects tended to focus more on the artistic attributes of the design while the occupational therapists were focusing more on the functional attributes of the design. This means that essentially the architects and the occupational therapists were taking different approaches to the same project.

[00:02:59] Architects are trying to design the building and meet certain codes, plus they’re trying to incorporate different design styles. While the OTs are purely focused on function. Oftentimes though the OTs would find themselves looking at just one person and their individual needs, and they would, unfortunately, cause the design to not work well for everyone else.

[00:03:21] The different approaches of these two professions led participants to suggest that they spoke a “different language”. Not only was this in regard to how the process was approached, but we found this to be the case in the terms used. Architects may not understand the terms or descriptions of disabilities that the OTs were using and the OTs would get lost in the design terms and their processes and their software being used.

Sarah: [00:03:45] Yeah. We’ve actually had experience with this as well. So, what ends up happening is the OT decides to learn about design and maybe try to figure out some design software. I’m guilty. I’ve done that. And the designer may take some courses on designing for aging and disability. There are lots of different courses that different design or building professions are putting out there about these topics.

[00:04:09] So that actually results in another profession dabbling in another’s work and not really understanding it fully. I do really like the quote from the article that says, “I don’t think much is gained by the OT trying to become an amateur architect or the architect trying to become an amateur health provider”.

[00:04:28] And it’s so true. Architects understand the science behind design and OTs understand the science behind human function. If they both learn to collaborate in a process that fit their knowledge base well, then the result would be a beautiful design that functions well for a wide variety of people.

[00:04:46] It’s also really important to understand the difference between designing universally and for one specific user. Like the article said, OTs can easily get caught in the trap of focusing on one ability when universal design is the outcome. But when you have universal design as the basis, you really have to look at how the design could be beneficial for all users. From those who are Blind to those who may temporarily use crutches from a broken leg. Or on the opposite end, you need to look at full-time caregivers for someone who has dementia or ALS. 

[00:05:19] Also to note, there are specific situations when focusing on one ability is necessary and essential. So I don’t want to negate that area of practice either. 

[00:05:29] So looking at our current business, we focus on universally and financially accessible homes. We knew that we had to have designers and OTs on the same page with the design from the beginning, because we focus on new construction and not home modifications. We wouldn’t have one specific user, so we had to develop a game plan that both professions could get on board with. We developed a process for collaboration because, like I said, there wasn’t really one out there that we could find. So each profession had the ability to be creative and to speak into the functional components of the design when it was needed. We also made sure people with disabilities had a voice in that design too.

Kati: [00:06:13] That makes sense that you changed to working collaboratively on a design to get all of the stakeholders involved.

The Earlier, The Better 

[00:06:19] Next, let’s talk about the second theme that emerged in the article, which was The Earlier, The Better. There are two quotes that really stood out in the research, and I’d like to share them with you.

[00:06:29] The first is “Occupational therapists were often described as being “called in” once the overall design had been completed to modify and adapt the original design as an afterthought”.  Another quote, states ” Late involvement of the occupational therapist in the process leads to expensive refits and additional modifications”.

[00:06:48] Sarah, you’ve experienced this, right? 

Sarah: [00:06:51] Yes. We’ve been called into multiple consulting jobs where we were there to evaluate a structure or the building after it was already built, and it was really frustrating because we felt like the changes we suggested would cost a lot of money and if they would’ve had us involved right from the beginning of the design, we would have saved them time and money on making those changes. 

[00:07:13] And that’s why in our current organization, we have chosen to focus on new builds instead of modifications to existing homes because it does take a lot of time and it is costly to make those changes later. 

[00:07:26] This past summer we did a few pilot projects with OTs and design students and it was really great to sit down with the designer and talk through the function of the space. While she moved the walls around and adjusted the details right on her design software. It was much more efficient this way and it was really great working right along with the designer in this process. These students collaborated really well together and you can actually see the results of that work on our blog.

Kati: [00:07:54] Yeah. The idea of student collaboration was also highlighted in the article through a quote that states “collaborative education and work needs to occur as early as possible in a practitioner’s career to have any hope of being successfully integrated into practice”. 

[00:08:10] And I can actually speak a little bit about collaborative education because I have some experience with interprofessional education at my OT school. I am in the OTD program at Murphy Deming College of Health Sciences at Mary Baldwin University. And our school is unique in that we are interprofessional by design. So our curriculums are designed to integrate occupational therapy students, physical therapy students and physician assistant students.

[00:08:39] So there are several classes that we all take together so that we as OTs can learn the perspectives of the PTs and the  PA’s, and they can learn our perspective as well. The reason that we do this is because in the real world when we all graduate and get our first jobs, it’s very likely that there is going to be collaboration among different healthcare professionals  and this is to make sure that the patient care is the best it can be. 

[00:09:05] So my school really wants us to be prepared and experienced at interprofessionalism before we even get out and start our first jobs. Now, unfortunately, we don’t have the opportunity to collaborate with students in design programs, but there are schools out there that do, and it’s incredibly beneficial for concepts such as universal design.

Sarah: [00:09:25] Oh, definitely. I’ve seen a few schools doing that with either OTs and landscape architecture or OTs and engineers. And there’s actually a lot of research out there that shows the benefit of doing this interprofessional collaboration during school. It does help build awareness of what other fields do, and it actually encourages collaboration in the field once they’re professionals.

[00:09:48] And I think it’s really rewarding because they get to learn about the other professional’s skills. And like we were saying up in the article earlier, we all have a different professional jargon and lingo and it’s nice to learn what some of the terms are for design when they’re touting off different things about the software, how that actually incorporates into their practice.

Kati: [00:10:11] So let’s move on to another quote from the article that stood out to me regarding the second theme that emerged. It says, “there is value in having first-hand experience of disability to inform their understanding of the need for universal design”. So basically what this is saying is that there needs to be someone with firsthand experience with disability at the table when we’re developing design plans so that they can provide input.

[00:10:34] Here at The Universal Design Project, we have a group of volunteers that we call Design Advisors who all have a unique personal experience with disability. They are either a person with a disability themselves. They might be a caregiver to someone with a disability. Or, they might be a health care professional or another service provider, like a case manager and they work closely with people who have disabilities. And all of these people bring their experiences to the table and they can help us understand how people use the environment and can tell us whether a design is a good fit or a poor fit for someone.

[00:11:11] So we really value their feedback on our design plans because it lets us know if we’re designing a home that works for a wide variety of people. So it’s essential that people who understand disability be a part of the conversation and be a part of that design process to ensure successful universal design.

[00:11:31] So if you’re listening to this and you want to volunteer as a Design Advisor, you can go to universaldesign.org/volunteer and fill out an application. 

Sarah: [00:11:40] Good idea. 

Universal Design as a Specialist Area

Kati: [00:11:42] So the last theme that emerged in this article is Universal Design as a Specialist Area. There were two very different perspectives that emerged within this one theme, and I will read a direct quote from the article to describe the first perspective. 

[00:11:59] It says, “In relation to occupational therapy, participants identified the need for universal design to be recognized and developed as a specialist area of practice .” 

Sarah: [00:12:09] I think this is true to some extent. The mindset of a traditional OT has to focus on adapting an environment for one person. This is very important in most clinical settings, but it is very different from the mindset of an OT working in universal design, as they need to focus on making sure all disabilities and all ages can use the same home or environment.

[00:12:31] Plus, we also have to make sure that we don’t design too much for one disability, so it becomes unusable for others. It’s also about making the home appealing and functional for people who don’t have a disability “right now” because really we’ll all have experience with it sometime. So just as OTs are specialists in hand therapy or sensory integration, universal design should be a  specialty area of practice too. 

Kati: [00:12:57] That is a good segue to the last quote we’ll chat through, which is “participants from the architecture and building industry argued that universal design and good design are one in the same, and the perception of it being a separate and specialist area causes some of the issues and collaboration between the professions”.

Sarah: [00:13:16] I don’t know how many times I’ve heard, “well, why don’t they just design it this way from the beginning?”  I think that’s what the idea of this quote is getting into, is that the idea of universal design is just really good design and why does it need to be considered something specialized?

[00:13:33] I agree that if people in this field just designed with the mindset from the start, we’d have more functional homes out there, but we all can’t work in our own little silos and really account for the variety of needs out there. You have to have input from those who understand disability from the professional and personal side of it.

[00:13:51] So all in all, I see both sides of both of these quotes. And I think that when you kind of merge them together and think through all of the details that they both are correct in some in some way. 

[00:14:03] So I also believe that this article has so much great information in it.  The barriers discussed really did help us fine-tune the direction we wanted to go with our current organization. It sort of feels like we’re paving the way for a new process of collaboration, but that’s what we feel like has to be done to make a difference in the housing market by getting designers, healthcare professionals, and people with disabilities all at the same table to discuss what is a good fit and what’s a poor fit.

[00:14:32] Thanks for listening and I hope you continue to join us for more discussions about universal design.

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