Kaylee’s capstone manual: Extensive Accessible Home Design Manual
Chart Kaylee discussed in the podcast.
The UD Project Course: Collaborative Teams for Optimal Outcomes
Interprofessional Collaborative Practice. World Health Professions Alliance. (2019). https://www.whpa.org/activities/interprofessional-collaborative-practice
Rachel Russell, Marcus Ormerod, Rita Newton, “The Development of a Design and Construction Process Protocol to Support the Home Modification Process Delivered by Occupational Therapists”, Journal of Aging Research, vol. 2018, Article ID 4904379, 13 pages, 2018. https://doi.org/10.1155/2018/4904379
Young, D., Wagenfeld, A., & Rocker, H. V. (2019). Universal Design and the built environment: Occupational therapy and interprofessional design teams—a scoping review. Annals of International Occupational Therapy, 2(4), 186–194. https://doi.org/10.3928/24761222-20190625-04
Sarah: [00:00:00] You’re Listening to Good Fit Poor Fit. A podcast that explores the interaction between people, design, and activity. Good Fit Poor Fit is part of The Universal Design Project, a nonprofit organization with a vision for every community across the USA to have a surplus of homes and opportunities for social participation that are universally and financially accessible.
Learn more at universaldesign.org.
Kaylee: Hello everyone. I’m excited to be back on the Good Fit Poor Fit podcast again. This time I wanted to bring to the table a discussion we can all relate to one way or another, collaboration. Some may get excited when they hear this term, others may shutter in a desperate attempt to avoid the conversation at all costs.
Interprofessional collaboration practice is when people from different professional backgrounds provide comprehensive services by working with patients, families, caregivers, and communities to deliver the highest quality of care across settings. This [00:01:00] collaborative approach also enhances the final product or outcome for the client.
I want to offer my capstone experience to present a process that us as occupational therapists or any profession really, can adequately and effectively communicate with others using a specific process. This process relates directly to home modifications, home renovations, or helping a client with a new build, as well as communicating with interior designers, contractors, builders, and other professions in the construction industry.
For the end product of my Capstone project, I created an extensive manual that talks about collaboration and important home design elements for aging in place and universal design. It is referenced in the show notes section of the podcast, but I wanted to bring to the table some important pieces that my manual on my last podcast with the Universal Design Project talked about.
Sarah Pruett: I am glad for you to share your work this semester, Kaylee, because I think all too often [00:02:00] there is a lot of conversation about needing to collaborate, but only a little direction on how. Plus, I think there needs to be more connection between the way someone in healthcare approaches a client, versus the way someone in a design field works through that process with a client too. Different professions do this differently and it’s difficult to match the phases up to collaborate effectively. I know you’ve done a lot of research on this, and I’d love for you to share that with our listeners.
Kaylee: Yes, and no matter what profession you are in, it is proven that interprofessional collaboration leads to better client outcomes, which as health professionals, is our goal in the first place. When discussing universal design in the home, it is most likely that you’ll be in contact or collaboration with an interior designer.
The very first week of my capstone project I attended the popular High Point Market, which is the largest home furnishing industry trade show where thousands of interior designers, businesses, and all attendees [00:03:00] gather to network, purchase furniture and attend seminars to grow their knowledge on various topics.
While I was there, I had the opportunity to collaborate with senior living interior designers and talk to them about the role of an occupational therapist and how our perspective is important. This discussion sparked many people’s interests during the aging in place and senior living design panel. It was encouraging to see an aging-in-place panel at the largest interior design market in the world.
Designers were curious about what occupational therapists have to offer in this setting and agreed that accessible homes are needed. Overall, it was a big success and evident that interior designers and occupational therapists could make a big impact working together when creating accessible homes.
Rebecca: This is a great example, Kaylee, of how simple conversations among professionals can lead to a more comprehensive understanding of what’s possible in a field. When we’re so enmeshed in our role and what our profession is typically [00:04:00] trained to do, it can become easy to almost exist with blinders on not realizing that there may be other things that would help us to achieve our aims as well. We can’t know what we don’t know. I think about this a lot in the overlap between design and OT. As OTs, we know what we bring to the table in terms of activity analysis and understanding human functioning. But someone who works in the design world might not know that we know that. They aren’t trained to analyze everyday activities and think about how spaces could be designed to make them easier for people who function in different ways. So why would they think about it in their work? And if they don’t know that OTs can do it, how would they know how to bring this perspective into what they make? In the same way that we aren’t taught to think about the aesthetics or the structural integrity of the DIY tools that we’re so often putting together for our clients. But, when these varying knowledge bases come together, I think that’s where the magic happens. Don’t you?
Kaylee: [00:05:00] Oh yeah, for sure. Coming off the high of those interactions, I knew I needed to educate others about how designers and OTs could collaborate in the final product of my capstone, my manual. When we break down each profession’s role, we see that occupational therapy practitioners bring a unique skillset to this specialty practice area and offer a distinct value to the design of spaces based on the consideration of the human lifespan, development and varying levels of ability.
Designing and redesigning homes for accessibility and aging in place can be challenging as it requires an understanding of the unique needs and preferences of all individuals. This includes considering issues such as mobility, vision, and hearing impairments, as well as mental health, which can have a significant impact on quality of life.
In contrast, interior designers know the art, science and business planning of a creative, technical, and functional interior solution that corresponds to the architecture of a space[00:06:00] , while incorporating process and strategy, a mandate for safety and health with informed decisions about style and aesthetics.
The OT and interior designer collaboration can share insights, experiences, and draw on the extensive knowledge and universal design principles, aging in place, activity analysis, and guided accessible design. I felt that adding this part to my manual would spark education and perspective on the possibilities we have to collaborate together within our clients’ homes and create a beautiful, aesthetically pleasing, functional, and safe space together.
When conducting the research and reading literature to review for my project, there was a consistent gap in establishing a collaboration process for both OTs and other service providers in the housing industry. Based on the study I found called The Development of a Design and Construction Process Protocol to Support the Home Modification Process Delivered by Occupational Therapists, [00:07:00] the authors indicate that a common model called the PEO, w hile good at guiding a therapist thinking to make sure the person, environment, and the occupations they do in the home are accounted for, it does not provide a process for operations and guiding the therapist step-by-step through the stages of helping a client with possible home modifications.
When just the PEO and other similar models were used on their own, it was stated that OTs were viewed as needing to be more organized, leading clients to be dissatisfied with their outcomes. This study recognizes that in order for OTs to be involved in the home effectively, there needs to be some form of process or protocol that can be followed to make sure all of the important pieces of the process are addressed.
In addition, it helps in the collaboration with other professionals to pinpoint what needs to be done, when, and how interaction and communication should occur at appropriate times when specific skill sets are needed.
Sarah Pruett: I think I would agree with this. The [00:08:00] PEO is a great overarching mindset, but it definitely doesn’t provide us a playbook and a protocol for collaboration. I’m glad to see this study, providing a collaborative process and framework to help guide these important professions in working together for patient outcomes.
Rebecca: I agree with this too. I think the PEO model is valuable for an OT to use within the collaborative process. In fact, I think that it is the special sauce that the OT will bring to the recipe. However, before the team starts cooking, to extend the metaphor, there needs to be some broader understanding of who everyone is, what their skills and knowledge bases are, and what their role is in designing a space that’s functional and inclusive. In fact, this is something that we have even played around with here at The Universal Design Project. On past projects, we’ve worked with architects, interior designers, rehab engineers, OTs, people with disabilities and their caregivers to put together examples of universal design in homes. It wasn’t [00:09:00] always easy, and we definitely didn’t always get it right, but we certainly learned a lot. Did you find any examples of structures that worked for this type of collaboration, Kaylee?
Kaylee: Yes! This process I mentioned earlier, the authors Rachel Russell, Marcus Armad and Rita Newton, based in the UK created within this research study. They’re using two models, familiar to home modification or universal design consultation. They compare the Generic Design and Construction Process Protocol phases with the OT model, Occupational Therapy Intervention Process.
They chose the OTIPM model because it separately operationalizes interventions. The authors studied and analyzed through a survey, online questionnaire, pilot study, and thematic analysis to come up with a protocol that combines the important elements in design and important input from an OT skillset.
Rebecca: Oh wow. Kaylee. I would love to hear more about that!
Kaylee: Next, I’m gonna talk about a chart that I’ve added into the show notes [00:10:00] so viewing that while I talk, may be helpful. The study divides the two models into nine sub-phases, implying that the number needed to complete the construction and home modification process. The model breaks the OT process down to correlate with the sub-phases to the construction process for increased communication during the design. The GDCPP main phases are pre-project, pre-construction, construction, and after completion. Whereas the main phases of the OTIPM are evaluation, modification planning, modification implementation, and reevaluation. The OT process consists of obtaining a referral, identifying the person’s occupational priorities, OT performance analysis, professional reasoning on modification design, confirming client consent on design, financial funding plan, providing ongoing support during modification, and documenting the outcome.[00:11:00]
Throughout the study, researchers discovered that collaboration was possible if each profession correlated sub-phases throughout the entire design process. This will promote effective collaboration by increasing communication, discovering each profession’s value, and reducing disorganization among team members and clients.
Now, I know we’ve discussed only a few interesting models and topics on collaboration, but I want you guys to hear from a different perspective as well. Rebecca, I was told that you have collaborated with Fortune 500 companies. Is there any input or suggestions, tips or information you would like the listeners to have from your experience?
Rebecca: Yeah, thanks for asking, Kaylee. You’re right. In my full-time gig, I work with employers to make their workplaces more inclusive for people with disabilities. This means everything from backend hiring and application processes to workspaces and even to company cultures of inclusion. This means I work with all kinds of people, human [00:12:00] resources, salespeople, talent acquisition people, diversity professionals, scientists, construction workers, programmers, anyone really looking to make their process within their company more inclusive. The most critical thing that I found is to start by getting to know what someone does and how their current process works. So if I’m working with a person who works in talent acquisition, for example, who’s in charge of hiring people and they want to make their hiring process more inclusive. First, I have to understand their role and the process that they currently use to hire people. I also have to make sure that they understand what I do and why I’m there. The expertise in disability that I bring to the table. Then once I can understand what they do, I can apply my OT lens and identify some opportunities for them to build more inclusive process. I can share my ideas, some of which may work and some of which may not be feasible. And that’s again, where the collaboration piece is important. I might have a great idea that I think [00:13:00] would really help them to make their hiring process more inclusive, but if based on their experience and their expertise, in their organization, they don’t think it will work. Then we scrap it because they’re the expert in what they do. This is quite similar to the process for collaboration in the design realm. The universal design experts and OTs could have great ideas that they think would drive inclusion, but if the person who is responsible for the structural integrity of the building, maybe architect or the engineer doesn’t think it’ll work, then the idea definitely needs some tinkering. The universal design team or OT could never expect to have the same knowledge that the engineer or architect does, but it’s only when those brains come together that they can create solutions that are actually well-rounded possible to execute.
Kaylee: That’s great advice. Sarah, I know you have collaborated with many professionals and have great experience in this realm as well. Anything you would like to add?
Sarah Pruett: Sure, I’d love to. [00:14:00] First, I wanna say that I do love the comparison that you gave in the process earlier for modifying existing homes and a clear pathway for adding in collaboration with the interior designer to provide specific recommendations for individual clients. Our organization is a bit different in that we are working on collaborating with new builds for universal design, for homes that don’t have a specific homeowner in mind. When we are trying to figure out how to collaborate with others, we knew that different voices would need to be contributed at different times. I can post a picture in the show notes of the process we derived from the concept of design thinking, but it outlines steps for the designer and the OTs to work together and on their own. Then we outline a step for asking for feedback from people who have lived experience with disabilities and those that may care for them like OTs, PTs, or caregivers. Their input helps the designer and the OT go [00:15:00] back to the drawing board or tweak that design to perfect it for function when looking at how the design can accommodate as many people as possible. Within that big process is an opportunity for communication to happen between the team to determine how that process goes within each of those phases. One great thing that came out of this process for us was to have an opportunity for all the voices to be heard about specific projects that we were working on from the designers, the OTs, and those who have a disability, or those that care for people with disabilities. As Rebecca can attest to, though it does get more complicated when you have many opinions. It really helped us as a team to think about what design choices would work for most people without overdesigning it to only work for someone with a specific need that wouldn’t be beneficial for others. And honestly, some design elements are really tough to make work for everyone, like countertop heights and appliance styles.
Rebecca: Oh, yes, Sarah. I couldn’t agree more. I’m having flashbacks [00:16:00] to sorting through all of the different inputs that we got when we were talking about where to put different appliances in terms of height. I think that that highlights some of the real big challenges that I alluded to earlier. There are benefits and drawbacks to having a lot of voices in the process. On one hand, it’s critical to make sure that functional, aesthetic, inclusive, universal, and human-centered considerations are made. But, on the other hand, that also sheds light on how many different perspectives, needs, and experiences exist. And that’s definitely one of the frustrating things about interprofessional collaboration, I think.
Sarah Pruett: Oh, definitely. I do think that brings up a good segueway to talking about communication and other barriers that tend to occur during collaboration. This is the stuff in the nitty gritty that you don’t really get to experience until you start collaborating. We actually go really deep into this topic of barriers and facilitators to collaboration in course number five on our site [00:17:00] called Collaborative Teams for Optimal Outcomes. I’ve linked that in the show notes too. Collaboration has to have a good process and protocol, like you said, Kaylee. And there are also other dynamics that come into play that can’t always be worked out with the protocol. One that’s important to mention here, I think, is professional cultures and stereotypes. When working with other professionals, it’s often common to not know all about that other person’s profession like we talked about a little earlier, maybe what they do and what they don’t do. We can come into it a little hazy on details from previous knowledge and maybe bias, and only sometimes see right away how both professionals can work together. Often with some effective communication, we can get past those initial barriers from how to approach a project, explaining things with terminology only those in certain professions may understand like shorthand names or acronyms. Another barrier that can come into play is determining how [00:18:00] collaboration occurs as sometimes there seems to be a hierarchy in one professional wanting to take the lead, or feeling that their perspective is more important than another. When it occurs, sometimes important features are missed in either form or function. I also think funding is a big part of how we collaborate as well. How does everyone on the project get paid? Especially if they’re coming at it from higher levels of education and knowledge. These are only a few barriers that come into play, but I will let you check out our course to dig into more of these collaboration factors. It’s quite interesting to realize the number of things that can pop up that you didn’t think would be a barrier to effective collaboration. I think the processes and protocols to collaboration are ever evolving and honestly must be something that works well for the individual partnerships that are made. Flexibility is important, but the more we try to work together, I think it will be easier and we can yield more optimal outcomes for our clients.[00:19:00]
Kaylee: Yes, I agree, Sarah. As a student pursuing OTs role in accessible home designs, I quickly discovered we must consider our knowledge base on design and construction in order to be successful in this emerging practice setting. Throughout my capstone, I found myself knowledgeable of the person, environment, occupation, and how all three of those interact together.
However, I was unaware of the lack of knowledge I had in the design and modification piece within a home. This education and knowledge base is needed to communicate the client’s wants or needs to the contractor, designer, or builder. As most may know if you have graduated or are a current student, there is not an abundance of material or time spent on home modifications or the design process within a residential home.
This must be sought out for additional education through experiences, courses, shadowing, and more. I currently just completed my CAPS one course, which stands for [00:20:00] Certified Aging in Place Specialist. It consists of three courses, and each course requires you to take and pass a test afterwards.
There are also additional courses and options such as the executive certification in home modification and universal design courses. The Universal Design Project also offers some educational courses on design guidelines for universal accessible homes, interprofessional collaboration, and how to address home accessibility in OT treatment and more.
Rebecca, do you have any closing comments on the importance of interprofessional collaboration or the efforts it takes on both professions to be successful?
Rebecca: I think we’ve done a pretty good job of covering this stuff and I’m glad that we really dove in here, particularly because we value and advocate for this type of interprofessional collaboration so much here at The Universal Design Project. The only final thought I’ll add because I will never pass up an opportunity to rep [00:21:00] for the non-traditional OT path, is that as OTs break out into these less traditional roles like we are, collaboration becomes increasingly important. The more that we’re in spaces outside of the typical healthcare realm, the more we will have to work with other professionals, understand what they do, be curious about that, and also remember how to demonstrate our unique value as well.
Kaylee: I totally agree. And once again, thank you for having me. My Capstone project, Extensive Accessible Home Design Manual is linked in the show notes if you want more information.
Rebecca: Wonderful. Thank you so much, Kaylee, and we wish you the best of luck in all of your future awesomeness in the world of OT. And to our listeners, we will be back in your feed real soon. Take care.
Sarah: Thanks for listening to Good Fit Poor Fit. I’m your host Sarah Pruett, Program Director and Occupational Therapist at The Universal Design Project. Learn more [00:22:00] about our work at universaldesign.org, and find more episodes and links to subscribe at goodfitpoorfit.com If you have questions or topics you’d like to discuss, email us at [email protected].
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