088: Collaboration: Experiences & Attitudes (Part 1)

Show Notes:

Overview of Themes and Subthemes

1. Factors Influencing UD Implementation (Part 1)
   1. Lack of Demand/Interest
      1. Consumers
      2. Professionals
   2. Systemic Barriers
      1. Lack of standards 
      2. Incentivization of UD implementation 
      3. The need for personalization
      4. Cost and aesthetics
2. Dynamics and Challenges of Interprofessional Collaboration (Part 2)
   1. Belief in interprofessional collaboration
      1. Value in a team of professionals working together with specific expertise
      2. Value in ongoing collaboration
      3. Professional growth
      4. Motivation to work with other disciplines
   2. Disconnect between professionals
      1. Attitudes and stereotypes
      2. Language differences
      3. Differences in processes
   3. Payment
3. Relevance to Occupational Therapy (Part 3)
   1. Therapeutic use of self
   2. Challenges OTs can help solve
   3. Availability of work

Transcript:

Sarah: [00:00:00] You’re listening to Good Fit Poor Fit. Our podcast is part of The UD Project, a small business rooted in occupational therapy that looks at how the design of a home environment impacts how well people of different ages and abilities perform everyday activities. We chat about this unique perspective to boost your knowledge and help you consider what can be changed in communities like yours.

Learn more about our work at universaldesign.org.

Hello, Good Fit Poor Fit listeners. Rebecca and I are back again with recently graduated Anisha Carr. Congrats to you, Anisha. If you remember from a previous episode, she was doing some research for her doctorate in occupational therapy at Towson University, and we wanted to give her the opportunity to share the results. So today we’re diving into a crucial aspect of universal design, interprofessional collaboration [00:01:00] in the design of residential homes.

Anisha: Thanks so much for having me back, Sarah and Rebecca. It’s been some time since my capstone ended, but it’s great to be back to share the results. The project took a lot of hard work between collecting data, analyzing, and writing up the results, but I’m really happy with the outcome.

Sarah: Yes, I can attest to all that work you’ve been putting in. Listeners, if you’ve ever done any type of research, especially interviews and analyzing the results, it’s a lot of detailed work, but very valuable.

Rebecca: Absolutely true, Sarah, and I know I’m honored to be here with Anisha and you to hear all about the findings. By now, I think everyone who’s listening knows what Universal Design is, but let’s go for another refresher just in case. Universal Design, or UD, is a concept focused on creating inclusive environments, products, and systems that are usable for a wide variety of people. For this episode, we’ll specifically focus on residential design, [00:02:00] design of homes. Despite the growing interest in universal design, there’s a significant challenge that remains, and that is limited interprofessional collaboration. And that’s where Anisha’s research comes in.

Anisha: Yeah, exactly. The initial goal of this project was to figure out why OTs aren’t more often included on interprofessional UD teams, and I focused my literature review around that. After exploring the literature more deeply, I realized that it was not only OTs being excluded from these teams, but rather there was an overall lack of collaboration in general. This lack of interprofessional collaboration can lead to designs that are not holistic and comprehensive and are based around only one professional’s expertise.

 For example, you can imagine a contractor who builds a kitchen with modified countertops that are lower and accessible cabinets. Though the contractor might understand UD or home modification principles and value the concept of different height countertops, they might not be able to understand the needs of the people who actually live in the house and the way that they engage in occupations. This is why having professionals who understand other [00:03:00] aspects of client needs, specifically the occupations that they engage in, and overall design concepts is really useful for home modifications and universal design.

Sarah: Right. There is a difference in following basic guidelines of UD or accessibility, kind of like a checklist of items or following certain measurements and then going beyond that to look at how all the individuals using that space will interact with the design. If you know who will be using the home, you have to make sure the design fits their needs and measure them in their equipment if they have it.

Just like your example with countertops, Anisha, even the typical topic of someone using a wheelchair is so varied in this situation. Many may think, oh, a person using a wheelchair, let’s make all the countertops lower, but power chairs sit up higher then most manual chairs even making the height of the sink, the width, and the clearance underneath of it difficult to determine unless you measure that exact person using a wheelchair in their home.

This is an [00:04:00] important step you don’t want to miss so you don’t have the sink up too tall or too low. Plus you want to account for others living in the home that might be standing and maybe they’re shorter or taller. These variables are important to consider and means flexibility needs to occur within the design.

Anisha: Yeah, I agree. It happens all of the time. After I decided to focus my project on overall interprofessional collaboration rather than just OT involvement. I began exploring the literature to begin identifying some of those barriers to collaboration.

Though I found many different potential barriers to interprofessional collaboration, such as lack of collaboration within the actual professional organizations and educational institutions of various disciplines. The barrier that seems to be least explored was the attitudes and experiences surrounding working with other professionals of different disciplines. I found very limited data on the actual subjective experiences of individuals who want to collaborate interprofessionally in the field of UD. And because of this gap in the [00:05:00] current lit, I decided to focus my project on the experiences and attitudes towards collaboration from actual professionals in the field. I use a transactional lens, which focuses on interactions between individuals. As we know, UD is not as commonly utilized as we’d all like to see. Though we understand the benefits, practically it’s just not commonly applied, and it’s very difficult to find professionals whose sole focus is UD. For this reason, my study included a lot of participants with a deep understanding of UD. However, most of them had the majority of their experience in home modifications, which we know is much more popular.

Rebecca: Yeah, that definitely makes sense given the state of the field right now. Even if people like the idea of universal design or want to integrate it into home modifications, there’s a component of working well together and overcoming those barriers of working across industry lines, which has to occur to do universal design well. And that isn’t always easy because… well, for a lot of reasons. So with all this in mind, Anisha, what [00:06:00] was the question that you were really seeking to answer in your research?

Anisha: Yeah, so the research question driving this whole project was how do the attitudes and experiences of UD practitioners prevent effective interprofessional collaboration and OT involvement in UD. I want to give you a brief overview of the methodology. So after I got IRB approval, I conducted 16 semi structured interviews on Zoom. With builders slash contractors, architects, interior designers, industrial designers, and OTs. I transcribed and coded their interviews and began to see themes emerge across disciplines, which allowed me to identify significant experiences and opinions. The findings were really complex and reflect the intertwined nature of UD, collaboration, and relevance to the profession of OT. Even though I really wanted to focus on attitudes towards collaboration, another significant finding from the interviews was regarding the frequency and normalcy of UD implementation. And that [00:07:00] really seemed to be a significant factor influencing interprofessional team dynamics, so I included it in my themes.

Sarah: I’m really glad that you were able to gather multiple professionals in a variety of different industries who often work in the UD world. I’m excited to hear the results and themes and how each professional’s experience overlapped in your research.

As a side note listeners, because we want to take the time to go through each of these three themes in depth and make it easy for you to follow along, we’ve decided to make this a three part series and discuss one theme per episode. I’ve included the entire outline in the show notes of all the three themes to give you an overview of the results, so you can see that if you would like. But in part one, which is this episode, we’ll dig into Factors Influencing UD Implementation. But please be sure to check out part two on Dynamics and Challenges of Interprofessional Collaboration, and then part [00:08:00] three of the series, Relevance to Occupational Therapy.

Rebecca: It sounds like a really thorough exploration. So let’s dive right in. What is the first theme that emerged?

Anisha: So the first theme relates directly to the factors influencing UD implementation itself. The challenges of implementing UD principles into new builds or remodels correlate to the effectiveness and frequency of projects that are done collaboratively. When the principles of UD are not understood, interprofessional collaboration isn’t seen as important. Conversely, collaboration is necessary to do UD effectively because there’s too much involved for one professional to have adequate knowledge about all of the design and human factors.

Sarah: Yeah, this makes sense, especially in your statement of when UD principles or concepts aren’t understood. In my experience, there’s a lot of misunderstanding of what UD and the details that go into those concepts.

They’re pretty multifaceted. [00:09:00] Plus, those details are intertwined for how all types of people do tasks differently within the environment. Collaboration and advocacy are so important to increase interest.

Anisha: Yeah, exactly. And that leads me to my first sub theme, which is lack of demand slash interest, which includes perspectives from consumers and professionals in the field. First, let’s start with consumers. The professionals I interviewed consistently highlighted that they had limited opportunities to implement UD features in the home and attributed this challenge to the attitudes among consumers that led them to not request or seek out accessibility accommodations until they were in urgent need. Here’s what one interior designer whose work is primarily in full remodels had to share.

Ruth: One lady called, she said ‘I really need you. My husband’s getting out, broke his hip and he’s getting out of the hospital tomorrow.’ What do you need me to do? Go pick him up? Like, you know. I just… we have passed that.

Anisha: This professional felt that working [00:10:00] with consumers post event or injury was out of her scope. It’s worth noting that many of the participants, primarily in the fields of occupational therapy and contracting, often find themselves providing services in a reactive manner and have built their business models accordingly.

Rebecca: Yeah, and I can see where this designer, for example, who gave that quote, would feel out of place because they probably are more used to having more time to implement a more integrated design. OT’s expertise could be used to conduct home assessments and to propose quick, affordable solutions to immediate accessibility needs. But they also have a seat at the table for more of the work that isn’t needed in urgent situations. More proactive work to design a home flexibly from the get go. This approach to service delivery highlights the gap between the ideal application of universal design and the reality of how home modifications are typically implemented.

Sarah: Yeah, I agree. Many consumers are coming into this in different parts of their journey. There’s a lot of [00:11:00] advocacy that goes into this work getting people to think ahead about the unexpected. Most of the time professionals are called in when there’s an immediate need and you don’t have the luxury to walk through the design and maybe make it more seamless and integrating into the home.

You often have to get that ramp up quickly and then come back later for other modifications. So what came about in your theme of lack of interest and understanding from professionals?

Anisha: So I found that professionals reported that their colleagues often prioritize factors such as cost, efficiency and aesthetics over integrating UD principles into their projects. There was a shared frustration among all groups of professionals that homes built by their colleagues seem to be very selective in the areas of accessibility they chose to address and in turn created homes that were very difficult to modify. One of the builders had this to share.

Robert: Even the patio homes and the carriage homes and the homes that are ostensibly designed and built for an older population, in most cases, they’ve got a step going into the house from the porch, they’ve got a step into the [00:12:00] house from the garage, and they’ve still got deep bathtubs that are hard to get into, they’ve got slippery floors, but they’re doing a little better on the wider doorways. But you know, it’s certainly not universal or accessible by any stretch of the imagination.

Anisha: This ignorance among building professionals and failure to address basic concerns such as slippery floors or deep bathtubs represents a broader theme of a lack of understanding and overall curiosity among building professionals towards addressing basic accessibility concerns, which leads to poorly thought out accommodations that require intervention from other professionals at a later date, which, as we know, is not cost effective.

Rebecca: Yeah, that’s certainly true, but I think that it’s, like we often have said before on the podcast, you can only know what you know. So building professionals are doing the best they can with what they have, and that’s where the interprofessional collaboration needs to come into play. You know, in this case, people hoping to build for an older population miss the mark often on actually putting in elements and features that are helpful for people they’re [00:13:00] trying to design for.

 But it doesn’t always come to fruition. So what’s the next sub theme, Anisha?

Anisha: The next sub theme in the factors influencing UD implementation is systemic barriers. We’ll cover lack of standards, incentivization of UD implementation, the need for personalization, and lastly, cost and aesthetics. A major challenge is the lack of standardized practice in UD, which leads to a disconnected approach among professionals and national and state regulations.

Sarah: I have also seen this in the literature in localities across the U. S. of there not being a UD standard of features, so it’s hard to evaluate if it’s even being implemented or implemented well. Plus, if there’s no standard, then what are you supposed to implement? Some people think adding in a few features and calling it UD is all they need to do, but there are so many features throughout an entire home that influence someone’s ability to do daily tasks well throughout the day.

 Tell me more about what some of the professionals said.

Anisha: So 6 out [00:14:00] of the 16 of the professionals I interviewed discussed challenges associated with the lack of standards. These findings show the disconnected approach to UD between professionals who aim to implement UD and state and national regulations. This leads to people being intimidated or making it up as they go.

Rebecca: Yeah, this lack of standards is something that I have heard come up so many times. And in my opinion, it’s kind of tricky. On the one hand, standards and checklists, things like the ADA, the Americans with Disabilities Act, and things like this can be helpful to guide people in what to look for or implement in designs to make them more inclusive. But on the other hand, universal design is so fluid and creative, it’d be tough to actually capture universality, in air quotes, in any sort of standard, just like you two noted at the top of this episode. One resource that I think could be relevant to this conversation here is the universal design building code that the universal [00:15:00] design project has put together. So this was designed actually in collaboration with design advisors who are people who have lived experience as a person with disability or as a professional working with people with disabilities and offers a variety of suggestions and design features in each space of a building that support inclusion. If you want to check this out, you can find it at: code.universaldesign.org. But before we digress too much, Anisha, what are some other things that emerged in your research?

Anisha: Yeah, so there was a discussion about incentivization of UD implementation. There’s an overall lack of grants, tax incentives, certification programs or recognition programs. These things do exist, but they’re very limited, and again, without standards, it’s hard to recognize who is implementing it properly. Without mandates for UD or accessibility in residential builds, building professionals do not prioritize the concept. Something I found that was very interesting is that 6 out of the 16 professionals drew [00:16:00] parallels between the incentives for environmental sustainability and the potential for incentivizing UD implementation. They observed that both concepts parallel each other in how the public perceives them and values them. So UD focuses on creating equitable environments for all individuals to thrive while environmental sustainability aims to minimize negative impacts on the environment to ensure a better future for all people.

Both of these things are kind of long term. Neither concept typically affects healthy, able bodied individuals, directly in the short term, leading to many building professionals, just completely deprioritizing them unless there is an incentive provided. To improve efforts toward environmental sustainability, which could easily be ignored, building professionals are often offered incentives, either monetary or recognition for implementing green design. For UD the framework used to implement incentives for green design might also be relevant, and it was brought up by a surprising number of participants.

Sarah: That’s really interesting. And I’ve also [00:17:00] found that these can vary from state to state and even in the local level for what people incentivize. It would be great to see more of this to get more people thinking about implementing UD in their communities. What else did your participants say?

Anisha: So another topic within this sub theme is the need for personalization. Good UD needs to be easily modifiable in order to cater to individual needs, especially those with complex requirements. I know a lot of times we think of UD as something that works for everyone, but it’s really important to acknowledge that personalization factor. This challenge was particularly noted by participants involved in home modifications, as well as those involved in UD, who found that they wanted to find solutions that could truly work for everyone, but it’s really not always one size fits all.

Rebecca: Back when the Universal Design Project was working on a lot of universal designs and getting input from our design advisors, it was apparent that the universal design principle of flexibility had to be part of the design process in this type of design. [00:18:00] We found that many features, we weren’t able to pick just one height that met all users’ needs or one type of appliance that was the most functional. You can design up to a point and then leave room for flexibility with an individual client. And I think this is why in a previous part of this episode, I said universal with air quotes because truly nothing, no design is actually going to work for everybody. On this note, an architect had a quote to share that fit into this theme. They said:

Duncan: 70% of what I suggest is just good universal design. My active listening is where the last 30% come from… That’s where I’m asking “What’s your family’s medical history?” ‘Cause my advice is different if everybody on your mom’s side went blind, if everybody on your dad’s side got Parkinson’s at 70.

Anisha: This participant highlights the foundational importance of UD principles in their work, while also noting that certain features must be somewhat personalized, depending on the needs of the client.

The last sub theme in this [00:19:00] section is cost and aesthetics. The most obvious and likely the most significant obstacle to the implementation of UD is the associated cost. The conversation around UD implementation costs is highly complex due to various factors, including the availability of grant funding and the comparison of UD costs with the expense associated with home modifications. Among the professionals in this study, 7 out of 16 highlighted cost concerns, noting that the expenses associated with both UD and traditional home modifications are a significant barrier for clients and professionals alike. While aesthetics play a major role in many participants interpretation of UD, prioritizing aesthetic elements particularly in home modifications, can lead to increased costs, sometimes resulting in designs that are financially inaccessible to many clients, resulting in people using the cheapest options so that their clients can utilize the space, in the short term.

Rebecca: Yeah, for me, the cost and financial accessibility piece is always the most frustrating. It [00:20:00] shouldn’t be the case that features that make homes more functional for people should be cost prohibitive, but oftentimes it is.

Sarah: Cost is one of the most common topics to discuss in this UD conversation. It impacts so much from building materials to product selection and covering cost of professionals, which we will go into in the rest of this three part series. It really has been a great conversation today, ladies, surrounding the first theme of Factors Influencing UD Implementation. Including demand from consumers and professionals plus different systemic barriers. You know, I’ve heard many professionals reference these barriers in all areas of the country. And Anisha your results span professionals from east to west coast in the U. S. and you had a few in other countries.

So I really feel like you captured responses that really do reflect the reality of implementing UD in 2024. So, if you are [00:21:00] excited about Anisha’s results, like we are don’t wait and jump on over to part two of this series. As we discuss dynamics and challenges of interprofessional collaboration from the perspectives of a variety of professionals involved in the design and build of homes. We’ll see you there.

Thanks for listening to Good Fit Poor Fit. If you want to learn more… first, find more episodes with transcripts and show notes at goodfitpoorfit.com. Don’t forget to subscribe! Second, check out our courses at go.universaldesign.org.

We cover housing topics like advocacy, collaboration, home modification, universal design and task adaptations. Lastly, if you have questions or topics you’d like us to discuss, email us at [email protected]. Thanks for fitting us into your day.