BEST PRACTICES FOR THE DELIVERY OF DRIVER REHABILITATION SERVICES, ORIGINAL DOCUMENT BY THE ADED BEST PRACTICE COMMITTEE JULY 2004

Transcription

1 BEST PRACTICES FOR THE DELIVERY OF DRIVER REHABILITATION SERVICES, ORIGINAL DOCUMENT BY THE ADED BEST PRACTICE COMMITTEE JULY 2004 REVISIONS BY THE PROFESSIONAL DEVELOPMENT COMMITTEE MARCH 2009

2 TABLE OF CONTENTS INTRODUCTION... 3 ADED BEST PRACTICES FOR THE DELIVERY OF DRIVER REHABILITATION SERVICES, Section 1: Interview/Medical History... 4 Section 2: Clinical Visual Assessment... 6 Section 3: Clinical Physical Assessment... 8 Section 4: Clinical Cognitive Assessment Section 5: Behind-the-Wheel Evaluation Section 6: Behind-the-Wheel Training/Intervention Section 7: Vehicle and Equipment Assessment Section 8: Client as Passenger Section 9: Documentation Section 10: Prescription/Equipment Recommendation Form Section 11: Final Fitting Section 12: Licensing Section 13: Quality Improvement ABOUT THE AUTHORS ADED 2009

3 INTRODUCTION The Association for Driver Rehabilitation Specialists (ADED) is a professional nonprofit organization that was established in 1977 to support professionals working in the field of driver evaluation and driver training. ADED s members are dedicated to enhancing the lives of individuals with disabilities and age-related impairments and changes by providing services that assist such individuals in the attainment of skills that enable safe, independent driving and transportation. This goal is accomplished through the application of driving strategies and training and the use of modified vehicles and adaptive driving equipment. The ADED Best Practices document should be used by any individual providing driver rehabilitation services for persons with disabilities or age-related impairments or changes that may impact driving. Membership in ADED commits members to follow the ADED Best Practices. Driver rehabilitation specialists possessing the CDRS (certified driver rehabilitation specialist) credential are likewise committed to such compliance. In writing the ADED Best Practices, the authors had full knowledge that this document does not stand alone. It is to be used in conjunction with the ADED Code of Ethics and Standards of Practice. Together, these documents form a firm foundation for the driver rehabilitation profession. Acknowledgments: Betty MacDonald served as Best Practices Committee chairperson, Vince Paniak served as Best Practices Committee facilitator, and Kathie Jane Regan served as Best Practices Committee liaison. In the development of this publication, Linda McQuistion was the content editor, and Jody Bailey was the copyeditor. The Professional Development Committee reviewed and updated the document in Serving as Chairman of the committee was Beth Rolland. Members were Mike Taylor, Kim White, Staci Frazier, and Carri Monagle. Important notice: This document is intended as a set of professional guidelines only, to be used by qualified driver rehabilitation specialists. To the best of the authors knowledge, it is based on the most current and timely information available at the time of publication. All driver rehabilitation specialists using this document must exercise professional judgment in its application to each client and his or her unique circumstances and apply it judicially. 3 ADED 2009

4 ADED BEST PRACTICES FOR THE DELIVERY OF DRIVER REHABILITATION SERVICES Section 1: Interview/Medical History Subject description: Determining the medical history and current status of the client s restrictions and medical challenges is required as a precondition to understanding his or her whole-person needs. Function 1.1 Determine the client s medical history Review all available past medical records (including physician s reports, therapy records, and any other medical reports) Interview the client and significant others about past medical conditions that may impact driving performance Strongly recommends that the client bring significant other(s) to the testing appointments. These significant others may participate in the interview process as permitted by the client to provide additional details, historical information, and/or other information. 1.2 Determine the client s current medical status 1.3 Determine whether there is a medical consent Review all available current medical records (including physician s reports, therapy records, and any other medical reports) Interview the client and significant others to determine his/her most recent medical events that may not be recorded in the medical records Review state/provincial laws in regard to medical conditions such as seizures Assess whether there is a medical consent to indicate that the individual is medically cleared to participate in the evaluation 1.4 Determine the client s current medications Review all available medical records Interview the client and significant others to determine any recent medication additions or changes Obtain information to understand the potential impact that medications can have on driving Interview the client to determine the effects that medications have had and/or are having on his/her driving ability 4 ADED 2009

5 Function 1.5 Assess the client s current communication status Review all available audiological testing results Interview the client to determine current hearing status Review all available medical records related to the client s communication status (e.g., speech therapy notes), including speech and comprehension Interview the client and significant others to determine any recent changes in communication status, including speech and comprehension and compensatory strategies currently used 1.6 Assess the client s driving history Interview the client and significant others to determine driving history 1.7 Assess the client s license status Review all available driving records. Requires client to bring current valid driving license, permit or any communication from the state or province s motor vehicle administration. Views and copies clients presented driving license, permit and/or information Determine the license validity and details Note any restrictions that have been placed on the license Note the date that the license expires 1.8 Determine the client s driving goals Interview the client to establish his/her driving goals 1.9 Determine the client s vehicle availability Interview the client to find out what vehicle(s) is/are available for use. 5 ADED 2009

6 Section 2: Clinical Visual Assessment Subject description: Driving is highly dependent on vision and excellent visual skills. There is a high prevalence of visual dysfunction in many of the populations the driver rehabilitation specialist serves. A thorough assessment of vision is necessary to evaluate and remediate visual dysfunction that may affect safe driving skills. Function 2.1 Determine the client s visual history Assess visual history from interview and medical records; include medication history as many medications affect vision Determine use of corrective lenses Obtain recent visual evaluations as needed Assess the need for further visual evaluation before continuing the evaluation process 2.2 Determine the client s visual acuity Test near and far vision using appropriate assessment tools; test monocular and binocular vision As appropriate for the patient population, screen for contrast sensitivity, glare recovery, night vision and color discrimination Know state/provincial guidelines for visual acuity. Advises clients when they do not meet requirements and requires referral to eye specialist. Requires further documentation from the eye specialist regarding client s ability to meet requirements before continuing to road testing or training visually 2.4 Assess the client s total field of vision (FOV) Assess bilateral visual fields using appropriate assessment tools in order to determine possible functional field loss Determine if client meets minimum visual field requirement for licensure in state/province in which they are licensed Educate client regarding functional field loss and how it may affect driving behavior. 2.5 Assess other Visual skills Test the client s ability to fixate on an object using appropriate assessment tools Assess client s ability to smoothly follow objects in space maintaining fixation in all directions while head is steady Evaluate the client s ability to quickly and accurately shift focus between two targets 6 ADED 2009

7 Function while head is steady Determine ability for eyes to move together toward the nose to see objects clearly and/or singly; determine blur point, break point, and recovery point Evaluate visual inattention using appropriate visual assessment tools and clinical observation Evaluate stereopisis using clinical testing methods Be alert to signs of visual dysfunction during clinical testing (e.g., head position, eye fatigue, etc.) Know where to refer individuals with visual dysfunction to determine whether the deficit is remediable 7 ADED 2009

8 Section 3: Clinical Physical Assessment Subject description: Strict compliance by the CDRS with these functional assessments ensures the client s suitability for driving. Function 3.1 Determine the client s range of motion as it relates to vehicle control requirements 3.2 Determine the client s strength as it relates to vehicle control requirements Perform range of motion measurements as necessary to determine the client s ability to operate original equipment manufacturer s (OEM) steering, gas/brake, and secondary control functions Perform range of motion measurements as necessary to determine the client s ability to operate adaptive driving equipment Perform cervical ROM measurements as necessary to determine client s ability to perform R/L traffic checks Evaluate for pain in back, neck, upper extremities or lower extremities during ROM and assess its affect on ability to operate vehicle controls Perform a functional strength assessment as necessary to determine the client s ability to operate OEM steering, gas/brake, and secondary control functions and load mobility device as necessary Perform a functional strength assessment as necessary to determine the client s ability to operate adaptive driving equipment Perform a functional trunk strength assessment as necessary for the driver to maintain an upright and stable posture while driving. 3.3 Determine the client s grip strength as it relates to vehicle control requirements Assess grip strength as necessary for the client s ability to operate OEM steering and secondary control functions Assess grip strength as necessary for the client s ability to operate adaptive driving equipment 3.4 Determine Client s Prehension status Assess functional prehension as necessary to operate OEM steering and secondary controls, and operate adaptive driving equipment. 3.5 Determine the client s sensation as it relates to vehicle control requirements Perform a sensory assessment as necessary to determine the client s ability to operate OEM steering, gas/brake, and secondary control 8 ADED 2009

9 Function 3.6 Determine the client s proprioception as it relates to vehicle control requirements 3.7 Determine the client s coordination as it relates to vehicle control requirements 3.8 Determine the client s muscle tone as it relates to vehicle control requirements and determine presence of abnormal reflex functions Perform a sensory assessment as necessary to determine the client s ability to operate adaptive driving equipment Evaluate proprioception as necessary to determine the client s ability to operate OEM steering, gas/brake, and secondary control functions Evaluate proprioception as necessary to determine the client s ability to operate adaptive driving equipment Assess coordination as necessary to determine the client s ability to operate OEM steering, gas/brake, and secondary control functions Assess coordination as necessary to determine the client s ability to operate adaptive driving equipment Evaluate muscle tone as necessary to determine the client s ability to operate OEM steering, gas/brake, and secondary control functions Evaluate muscle tone as necessary to determine the client s ability to operate adaptive driving equipment Interview the client to determine whether changes in muscle tone have occurred that were not observed during the evaluation 3.9 Determine the client s mobility status Review available therapy records to determine mobility status, including average length of independent ambulation, assistance needed, and any changes in mobility status throughout the day Observe the client ambulating as indicated Interview the client to ascertain whether there have been any recent changes (increase or decrease) in ambulation Interview the client to determine fall history 3.10 Determine the client s balance Evaluate the client s balance while he/she is sitting, standing, and walking (in clinic and in vehicle) 3.11 Determine the client s orthotic devices Review the client s current orthotic devices (e.g., splints, ankle foot orthoses, back braces, etc.) 9 ADED 2009

10 Function Interview the client to determine whether different orthotic devices are planned for the future 3.12 Determine the client s mobility aids Review the client s current mobility aids (e.g., cane, walker, manual wheelchair, power wheelchair, scooter, etc.) and evaluate them for functionality Refer the client to appropriate professionals as needed to address mobility aid issues Interview the client to determine whether different mobility aids are planned for the future 3.13 Determine the client s transfer skills Interview the client to determine current skills in transferring into and out of a vehicle, with or without adaptive equipment, and for loading their mobility device (as necessary) Evaluate the client s ability to transfer into and out of the assessment vehicle Evaluate the client s ability to transfer into and out of his/her vehicle, if available 3.14 Determine the client s reaction time as it relates to vehicle control requirements Evaluate the client s reaction time as it relates to operating OEM gas/brakes Evaluate the client s reaction time as it relates to operating adaptive driving equipment When evaluating reaction time, attends to relevance of testing time to standards and expectations of testing tool. Notes abnormal motor movement patterns, potential for impaired strength, ROM, and coordination versus attention and/or visual response to testing stimuli Plans to simulate emergent braking response and brake reaction when in the actual motor vehicle, prior to using public roadways. Plans to note correlation from clinic testing to vehicle testing. 10 ADED 2009

11 Section 4: Clinical Cognitive Assessment Subject description: Cognitive impairments require interviews and evaluations using valid assessment tools, along with other resources, to determine the effect of the impairment on a client s potential driving risk. Function 4.1 Determine the client s past and current medical history and diagnosis underlying or contributing to cognitive impairment (recognize and screen for comorbidities) 4.2 Determine the client s and significant others awareness or understanding of current medical status as it relates to cognition 4.3 Determine the presence and level of cognitive impairment Review all available past and current medical records to determine cognitive impairment (including physician reports, therapy records, and any other medical reports) Recognize and review relationship of cognition to diagnosis or medical condition (e.g., multiple sclerosis and memory impairment, dementia and memory/learning) Review medications; ascertain whether medications may consistently or inconsistently impact cognition Interview the client and significant others, with sensitivity to cognitive impairment Interview for evidence of self-limiting behaviors or strategies client has identified or implemented that reflect self-awareness Use professional judgment to administer an optimal array of assessments appropriate for an individual client Use clinical judgment to observe cognitive domains during clinical and on-road performance Pay special attention during the on-road assessment to observing performance and challenging cognitive domains of concern for the specific client s medical condition or diagnoses 4.4 Determine level of self-awareness Interview the client for indication of willingness to employ strategies or compensations; use clinical judgment regarding the client s potential for insight and behavioral change within the capabilities of the condition of cognitive impairment (diagnosis) Assess the client s response to feedback and indications of self-awareness of deficits during the on-road assessment Attempts to gather information from client s significant other in determining if client can 11 ADED 2009

12 Function 4.5 Determine appropriate intervention to address needs related to cognitive impairment (in context of driving) 4.6 Reassess for progressive conditions (such as dementias) 4.7 Determine the presence and level of visual perceptual impairment provide factual information. Looks for areas of discrepancies between function as related by the client and significant other or other medical documentation Understand the implication of cognitive impairment on the potential for learning (strategies and/or equipment compensations), remediation, and training Know resources for referral (e.g., treatment or remediation of deficits or other appropriate services) Understand the rationale/policy that describes the protocols and recommended schedule for periodic reassessment for progressive conditions (such as dementias) Recommends re-evaluation in formal documentation to client and referral source. The client and significant others are counseled to return for additional evaluation with any functional decline, after any acute medical episode or upon the addition of any medical conditions that could exacerbate cognitive decline/changes Use professional judgment to include the optimal array of assessments indicated for an individual client Use clinical judgment to observe visual perceptual skills during clinical and on-road performance 12 ADED 2009

13 Section 5: Behind-the-Wheel Evaluation Subject description: A behind-the-wheel evaluation can determine the impact on driving performance of evaluation deficits that are or may be present. Although nondriving assessments are important, a practical driving assessment is crucial to understanding a client s strengths and weaknesses behind the wheel. Function 5.1 Assess the appropriateness of the evaluation vehicle and/or equipment to meet the client s evaluation needs 5.2 Assess the client s ability to enter and exit the driver s station with or without adaptive equipment 5.3 Assess the client s ability to manage existing mobility aids with or without use of adaptive equipment 5.4 Assess the client s ability to obtain and maintain appropriate driving position with or without adaptive equipment Understand the impact of physical limitations on driving performance Assess vehicle/equipment appropriateness to meet the client s evaluation needs Make an appropriate referral when the client s needs cannot be met with available vehicles(s) Observe the client s ability to safely and efficiently enter and exit the driver s station with or without adaptive equipment If equipment is needed, apply ADED Best Practices, section 7, subsection Observe the client s ability to safely and efficiently manage existing mobility aids with or without use of adaptive equipment If equipment is needed, apply ADED Best Practices, section 3, subsection Observe whether the client is able to physically operate controls for seat positioning, steering wheel positioning, mirror adjustments, lower extremity positioning, and seat belt use Observe the client s ability to cognitively recognize the need for appropriate positioning and the ability to make needed adjustments to obtain appropriate positioning Observe whether visual limitations impact client s ability to obtain appropriate positioning If equipment is needed, apply ADED Best Practices, section 7, subsection Assess the client s ability to maintain position over time, on different roadway conditions, and at varying speeds 13 ADED 2009

14 Function 5.5 Assess the client s ability to satisfactorily operate primary controls with or without equipment 5.6 Assess the client s ability to operate secondary controls with or without equipment and with the vehicle stationary and in motion 5.7 Assess the client s driving performance in progressively complex traffic/roadway conditions and weather conditions similar to those they would normally encounter 5.8 Determine an appropriate graduated process for the evaluation Observe the client s ability to operate OEM gas, brake, and steering controls Assess cognitive and visual ability to operate OEM controls or necessary adaptive driving equipment If equipment is needed, see ADED Best Practices, section 7, subsection Observe the client s ability to operate OEM signals, wipers, ignition, lights, window controls, mirror controls, seat positioning controls, climate controls, seat belt controls, radio controls, cruise control mechanisms, horn, gear shift control, dimmers, and parking brake control while the vehicle is stationary Assess the client s ability to operate signals, wipers, horn, cruise control set, and dimmer controls while the vehicle is in motion Assess the client s cognitive and visual ability to operate all secondary controls with the vehicle stationary and in motion If equipment is needed, see ADED Best Practices, section 7, subsection Assess the client s driving performance in a variety of appropriate conditions that may include but are not limited to parking lots; minimal to heavy traffic; commercial, residential, rural, freeway, and highway traffic; etc Take into account the client s driving goals when determining in which conditions to conduct the evaluation Establish and follow evaluation criteria Makes recommendations regarding night driving or weather conditions based on clinical findings, road performances during normal daylight hours OR by actual observation of skills in variable weather or lighting conditions Recognizes that clients that have low vision may benefit from driving in varying lighting conditions to ascertain possible limitations. Includes various lighting conditions in evaluations or during training Assess the client s driving performance using a graduated process only to the degree needed 14 ADED 2009

15 Function 5.9 Assess the impact of cognitive/perceptual, behavioral, and visual limitations on safely performing all driving tasks in the conditions encountered 5.10 Assess the safe use of necessary adaptive driving equipment 5.11 Assess the potential for improved safety with use of equipment and/or compensatory strategies for physical, visual, cognitive/perceptual, and/or behavioral impairments affecting driving performance to evaluate the presence or absence of safe driving performance Recognize the need to further assess complex situations once safe in less complex situations Observe the impact of the client s limitations on his/her ability to perform appropriate lane placement, turns, and speed control; to interpret signs, signals, and road markings; to be aware of his/her environment; to manage time and allocate space; to identify and appropriately respond to actual or potential hazards; to understand and use the road system; interact with other road users The driving evaluation route includes both directed navigation and self-directed navigation, which requires executive cognitive skills such as planning and searching for an unfamiliar street or landmark. This may also include navigating highways by reading and responding to highway directional signs and information Assess the presence or absence of common errors associated with first-time users of equipment Assess the potential for the presence of these errors beyond evaluation conditions Assess the impact of cognitive limitations on the client s ability to learn and consistently use equipment Begin training in an identified area of concern and note impact on performance Determine the degree of cognitive and/or behavioral limitations that may affect the impact of the learning process Assess the degree and number of limitations as they relate to obtaining stated driving goals Assess the client s ability to recall and consistently use compensatory strategies beyond the training period Assess the potential for continued decline in cognitive/perceptual, visual, physical, and/or behavioral functioning 15 ADED 2009

16 Function 5.12 Assess the impact or potential for impact of fatigue factors on driving performance and stated driving goals 5.13 Assess current vehicle appropriateness or need for vehicle change per ADED Best Practices, section Assess appropriate equipment needs per ADED Best Practices, section Determine the outcome and options and review them with the client Understand potential fatigue factors such as those related to disabling conditions, medications, lifestyle, time of day, and so forth Assess the presence or absence of fatigue and its impact on driving performance, the reaction to types of conditions encountered, and so on Assess fatigue factors as they may relate to stated driving goals Apply ADED Best Practices, section 7, subsection Apply ADED Best Practices, section 7, subsections Indicate whether the client is safe to drive, unsafe but could benefit from training, or unsafe and should refrain from driving Identify further interventions needed by other professionals with reassessment in future Provide resources for Identify whether reassessment is periodically needed because of the progressive nature of the condition Identify available alternative transportation options Assess the client s level of understanding of and compliance with reviewed recommendations 16 ADED 2009

17 Section 6: Behind-the-Wheel Training/Intervention Subject description: Goal setting and planned stages of training after the behind-the-wheel evaluation are critical in ensuring that the client understands the process of maintaining safe driving performance. Flexibility in the plan is also an inherent factor that will ensure reduced frustration by the professional and the client as he/she works toward timely independent mobility. Refer for intervention as necessary (neuro-optometrist, physical therapy, occupational therapy, etc.) Function 6.1 Set goals Identify specific driving goals Establish a timeline for meeting goals Establish a system for measuring progress 6.2 Provide training consistent with driving-specific goals 6.3 Provide training in a variety of conditions and environments (consistent with driving-specific goals) Train clients regarding the use of equipment, pre-driving habits, lane positioning, secondary control use, signs, lane markings, following distance, mirror use, lane changes, highways, merging, turns, shopping centers, parking, backing up, and so forth Observe proper skills in the above areas Establish a plan to deliver as much change in conditions and environments as possible Observe proper skills 6.4 Adjust goals as needed Use best judgment to determine whether goals need to be adjusted on a ride-to-ride basis, depending on the client s performance Expect progress with each ride in general; three to four rides without progress may be grounds for intervention or discharge 6.5 Ensure that intervention treatment is consistent with diagnosis problems Provide referral recommendation and information as appropriate 17 ADED 2009

18 Section 7: Vehicle and Equipment Assessment Subject description: Evaluating various aspects of the client s vehicle and equipment needs requires planned and logical processes involving interviews and assessments. These approaches ensure maximum client satisfaction and professional standardization of CDRS practices. Function 7.1 Determine the funding source for driver evaluation, training, and adaptive equipment 7.2 Determine whether the client has completed a clinical driver evaluation Assess from interview the client s ability to cover the costs of driver evaluation and driver training, as well as vehicle insurance, tags, taxes, and so forth Inform the client of funding options: vocational rehabilitation, loans, and rebate programs Assess whether the client has had a clinical assessment following the ADED Best Practices guidelines As state/province allows, contact the licensing agency if there is a question as to possession of a valid driver s license/permit Assess whether the client has been medically cleared by a physician to return to driving Assess whether a vehicle prescription has been written for the client Educate the client regarding vehicle insurance issues and mobility equipment dealers 7.3 Help to select a mobility equipment dealer Educate the client about National Mobility Equipment Dealers Association s (NMEDA) Quality Assurance Program accreditation and provider resources (i.e., mobility equipment dealers) 7.4 Assess the client s ability to enter and exit the vehicle Assess the client s ability to transfer a mobility aid in and out of his/her existing vehicle Assess the client s ability to drive or to be transported in the current vehicle Determine the viability of the existing vehicle Measure the client in the mobility aid Assess the vehicle for power steering, power brakes, and automatic transmission (if the client will be driving this vehicle) 18 ADED 2009

19 Function 7.5 Determine replacement vehicle options Assess the client s preference of vehicle Discuss options with mobility equipment dealers Discuss the importance of not exceeding gross vehicle weight rating (the maximum weight allowed by the manufacturer when a vehicle is fully loaded) Present options to the client for approval 7.6 Determine the primary controls for driver setup 7.7 Determine the need for accessory switches that complement primary and secondary switches 7.8 Determine the steering actuation of the vehicle 7.9 Determine the client s ability to enter and exit a van Assess the client s need for gas/brake or brake only Assess the client s need for mechanical or electric hand controls; be knowledgeable about options regarding various types of controls Assess the client s need for steering controls in conjunction with hand-control operation Assess the client s need for pedal extensions (typically there is no gas extension without brake extension) Assess the client s need for a left foot accelerator and a pedal block for right accelerator Assess the client s need for a parking brake modification Assess the client s ability to use driver-side controls of windows, defroster, wipers, lights, turn signals, horn, gear selector, and so on while the client is restrained as a driver Assess the client for cruise-control use Assess the client s ability to use the heating, ventilation, and air conditioning system Assess the client for a steering prosthetic Assess the client for standard-effort steering, low-effort steering, or no-effort steering Assess the client s range of motion for steering wheel size, true-extended steering column, horizontal steering column, and high-tech steering system Assess for a backup system anytime low-effort or no-effort steering is required Assess the client s use of a functionally equivalent vehicle to determine other issues Assess the client s need for a raised roof or door Assess the client s need for a lowered floor 19 ADED 2009

20 Function 7.10 Determine the client s ability to obtain an appropriate driving position Assess the client s ability to transfer to a power seat base using the existing OEM chair If the client cannot transfer out of his/her wheelchair, assess the client for proper eye level behind the steering wheel Assess the client s ability to quick disconnect the seat base and store it when not in use Assess the client for trunk stability and independent seat belt use of three-point lap and shoulder belt to meet federal motor vehicle safety standards (FMVSS) Assess the client for fully independent operation of power doors, door/lift switches for internal and external use, home or work variables for entering and exiting, and so forth 7.11 Determine key/ignition activation Assess whether the client can use the OEM ignition and make appropriate recommendations 7.12 Determine the client s ability to handle emergency situations 7.13 Ensure compliance with existing standards and guidelines Recommend a hands-free cellular phone that the client can independently operate as needed Compare recommendations to existing standards and guidelines (e.g., FMVSS and NMEDA guidelines) to ensure that all items are compliant Be aware of gross vehicle weight and general weight concerns regarding modified vehicles 7.14 Know resources Know what resources are available and where to locate equipment and service providers to ensure that the client is served in a timely manner 7.15 Advise and assist clients with meeting regulatory requirements of state/provincial licensing agency for driving with adaptive equipment Provide instruction/assistance in completing required road test and/or license changes to reflect adaptive equipment 20 ADED 2009

21 Section 8: Client as Passenger Subject description: Even when a client is to be a passenger rather than a driver, it is still crucial to determine the client s ability to transfer into and out of a vehicle and to evaluate the vehicle s appropriateness for safely transporting the client and any accompanying mobility aids. Function 8.1 Determine whether the ambulatory client, with or without mobility aids, will enter/exit from the rear or the side of the vehicle 8.2 Determine whether the client with a mobility aid will occupy a passenger seat and store the mobility aid 8.3 Determine whether the mobility aid dependent client will occupy the device while riding as a passenger 8.4 Assess the vehicle s capability for wheelchair or scooter transport Assess the client for stability, strength, and balance under actual conditions Evaluate mobility aid stowage and securement Assess the client s ability to enter and exit the vehicle Determine the fit between mobility aids and vehicle storage area Review various terrain conditions and locations as they apply to the client s ability to transfer Inform the client of the loss of seating or storage options Assess the client s transfer capabilities in a confined area Review mobility aid securement Inform the client of the loss of seating or storage options Assess the client s position in the vehicle, including headroom Determine the client s eye level-line of vision as appropriate Ensure that the vehicle has manual or power wheelchair tie-downs with a separate occupant restraint system Ensure that the client is facing forward with a four-point wheelchair tie-down system that has a seatbelt separate from the wheelchair Inform the client that he or she must transfer off a scooter while riding in the vehicle Assess the vehicle for appropriate tie-downs for a scooter Be aware of gross vehicle weight and general weight concerns regarding modified vehicles Ensure that unoccupied mobility aids can be properly secured 21 ADED 2009

22 Section 9: Documentation Subject description: The CDRS should maintain documentation of the client s performance in all areas of service provision. Function 9.1 Maintain written and electronic records of all services provided while respecting client confidentiality 9.2 Release documentation with respect to the client s privacy Include the following documentation as necessary: contact information, consent/release form, evaluation, training records for each session, prescription/equipment recommendation form, federal and state or provincial licensing documentation, all correspondence, billing records, and discharge records Ensure that the client has signed a release of information form per Health Insurance Portability and Accountability Act requirements and facility, federal and state, or provincial regulations and guidelines Provide documentation to referral source, payer, equipment provider, client and others as directed or required by regulation, informed consent or release of information forms. 9.3 Records Retention Records will be retained in an orderly fashion for time periods that comply with legal and governmental requirements for the state/province in which the professional resides and practices in and according to employer s established policy and procedures. 22 ADED 2009

23 Section 10: Prescription/Equipment Recommendation Form Subject description: A preparatory step in producing the prescription/recommendation form is generating a holistic report that includes all the findings from the various assessments and evaluations. After the report is generated, the prescription/recommendation form for all vehicle and equipment needs of the client is the last step in the driving evaluation. The recommendations in the form should be based on the client s demonstrated performance in an actual driving experience with a vehicle and equipment functionally equivalent to that which is being prescribed and as required by state/provincial regulations. The prescription/equipment recommendation form may be provided to the client, a third-party payer, a physician, and a mobility equipment dealer selected by the client when requested by the client or established by local practices. Function 10.1 Generate an all-encompassing, holistic report that includes all of the findings from the various assessments and evaluations 10.2 Base the prescription/equipment recommendation form contents on actual client performance in a vehicle and with equipment functionally equivalent to that necessary for safe driving performance 10.3 Make the prescription/recommendation form as complete and specific as necessary for each client s situation Ensure that the contents of the report lead to the ultimate conclusions that the prescription/recommendation form will contain Conduct an assessment of needs/skills in an evaluation vehicle and with equipment functionally equivalent to those required to meet the client s needs as required by ADED Best Practices, section When available, include the specific vehicle(s) to be used by the client Include all necessary specific vehicle modifications Include all necessary primary and secondary control equipment and its positioning in the vehicle Include all necessary mobility aid management systems and vehicle positioning/securement equipment Include all necessary communication system and positioning management equipment Include all necessary driver restraint system equipment, modifications, and positioning systems Include all necessary auxiliary equipment 23 ADED 2009

24 Function 10.4 Provide copies of the prescription/recommendation form to the client and other parties as deemed necessary by local, facility, and third-party payer practices Provide appropriate parties with a copy of the completed form Demonstrate knowledge of local, facility, and third-party payer regulations regarding the prescription/recommendation form Follow local, facility, and third-party payer regulations Maintain a copy of the prescription/recommendation form in the client s permanent record in accordance with state/provincial and facility regulations Attends in-services and collaborates with manufacturers and mobility equipment dealers to keep updated on industry changes, new safety standards, and new vehicle models that may affect mobility equipment prescriptions. 24 ADED 2009

25 Section 11: Final Fitting Subject description: The CDRS should contact the client and mobility equipment dealer following vehicle modification and equipment installation to ensure optimal functioning of the vehicle and equipment per the prescription/equipment recommendation form within the limits imposed by geographic location and client cooperation. ADED recognizes the need to balance costs, safety and reliance on the qualified mobility equipment dealer. For high tech and custom equipment, and to assure that correct and prescribed equipment is installed and safely usable, final fittings are recommended. Individual programs will develop policies and procedures in conjunction with their own Risk Management and Legal departments to address final fittings. Function 11.1 Ensure that the recommendations in the prescription/equipment recommendation form have been followed 11.2 Ensure optimal client functioning with modifications performed and/or equipment installed per the prescription/equipment recommendation form Ensure that specific vehicle modifications are present Ensure that all prescribed equipment is present Ensure that the placement of equipment is per the prescription/equipment recommendation form Note the presence of variances from the prescription/equipment recommendation form and reason for variances Assess the appropriateness of variances noted Assess the client s ability to enter and exit the vehicle Assess the client s ability to manage mobility aids if applicable Assess the client s ability to assume the appropriate driving position Assess the client s ability to safely operate all primary controls, secondary controls, mobility aid management systems, securement systems, and communication systems as appropriate Provide recommendations for specific adjustments or modifications as needed Assess appropriate outcome of adjustments or modifications when they are completed As allowed by the facility s policies and risk management department, assess the client s ability to safely operate the vehicle in driving environments Document outcomes from the final fitting If geographical limitations or facility policies prohibit final fitting, attempt to locate a local 25 ADED 2009

26 Function professional who may be able to conduct the final fitting If the client refuses to participate, or has purposely chosen alternative vehicle modification, document the refusal and notify appropriate third parties as deemed necessary for state, provincial, facility, or program policies and procedures 11.3 Provide follow-up training as necessary As allowed by the program s policies or risk management department, pursues additional training with the client and his/her vehicle and equipment to ensure skill proficiency as necessary 26 ADED 2009

27 Section 12: Licensing Subject description: Determining licensing standards is critical to reduce CDRS liability and to ensure that risk-management initiatives are implemented. Function 12.1 Assist clients in meeting state/provincial licensing requirements specific to their situation Understand licensing issues in the state/province for cancellation, renewal, restrictions, reinstatement, permits, disabilities, equipment, and so forth Educate client on steps to take to ensure licensing requirements are met Educate other professionals who are required to participate in licensing issues per state/provincial requirements Provide state/provincial licensing forms to the client and other professionals to aid in expediting licensing issue resolution when applicable 27 ADED 2009

28 Section 13: Quality Improvement Subject description: It is critical that CDRSs maintain a high level of competency through ongoing education. This ensures that the client is treated according to professional standards that are not only maintained, but also upgraded when new concepts and practices are developed. Function 13.1 Obtain ADED CDRS credentials Sit for and pass the ADED CDRS examination 13.2 Maintain CDRS credentials Pursue continuing education opportunities per certification requirements 13.3 Maintain a current knowledge base Attend continuing education opportunities that may include but are not limited to ADED conferences or courses; regional, state, or local community courses related to subject matter appropriate for driver rehabilitation; and professional organization courses or conferences related to driver rehabilitation Review literature relevant to driver rehabilitation Maintain networking with others in the driver rehabilitation field 13.4 Establish a program-based quality improvement system Establish a system to review program outcomes in areas such as clientele served, types of equipment prescribed, result of program participation, length of program involvement, and so forth Assess program changes on the basis of outcomes review 28 ADED 2009

29 ABOUT THE ORIGINAL AUTHORS Dan Basore, BSEd, MSA, CDRS, is a resident of Hatfield, Pennsylvania. Dan attended college at West Chester University, where he obtained his bachelor s degree with a minor in drivers education and a master s degree in health care administration. Since 1980, he has been working at Moss Rehab Hospital in the adaptive driving program and is currently the program director there. For this program, he travels regionally to perform numerous driving evaluations. He is currently serving on the Society of Automotive Engineer s Adaptive Devices Committee and is a past member of the ADED Certification Board. He has given frequent presentations on elderly driving at ADED conferences, local hospitals, schools, and the Veterans Administration. Lori Benner, MPA, OTR/L, CDRS, is an occupational therapist with more than 20 years of experience. She began her career working with the school system and later went on to work at the Penn State Rehabilitation Center, where she specialized in spinal cord injury and where she assisted in writing the first grant that started the driver s rehabilitation program in the early 1980s. In 1997, Lori became a CDRS, and she currently manages the driver s rehabilitation program and other rehabilitation programs at the Penn State Rehabilitation Center. She has also served on the Society of Automotive Engineers Adaptive Devices Committee from 2003 to the present. She has been the editor of News Brake (ADED s quarterly newsletter) for the past 4 years, which has provided her the opportunity to meet many of her colleagues and see firsthand how complex the organization is and how involvement from everyone is key to its success. Lori is currently the president elect of ADED. Elin Schold Davis, BS, LOTR, CDRS, is an occupational therapist residing in Minnesota. She has a bachelor s degree in occupational therapy from the University of Minnesota. She has worked in clinical practice for 25 years with a focus in the areas of cognition and driving and has lectured extensively on brain injury rehabilitation, cognition, and driving. Her current position as the coordinator of the American Occupational Therapy Association s Older Driver Initiative involves a variety of programs to serve the growing needs of the older driver through the development of educational opportunities for occupational therapists and students; through the production of a practice guideline, including an evidence-based literature review; and through the development of driving-related resources, including a web-based Microsite. Ann B. Havard, BS, LOTR, CDRS, ATP, lives in West Monroe, Louisiana, and attended college at the University of Louisiana, Monroe. She obtained a bachelor s degree in occupational therapy in 1981 and has worked in a variety of facilities since that time, including residential facilities for the developmentally delayed, acute care hospitals, home health agencies, and public schools. Ann has been an occupational therapist at the Center for Biomedical Engineering and Rehabilitation Science at Louisiana Tech University for the past 15 years, where she serves as the driver rehabilitation program manager. Ann also performs assessments in the areas of computer access and augmentative communication. She has taught courses regionally and nationally in the area of assistive technology with an emphasis on driver 29 ADED 2009

30 rehabilitation and augmentative communication. In addition to her CDRS credentials, Ann is also certified by the Rehabilitation Engineering and Assistive Technology Society of North America as an assistive technology practitioner, and in 2001, she received the ADED Scholar Award. Deena Garrison Jones, BS, LOTR, CDRS, is the founder and manager of Boundless Mobility and has over 16 years of experience working with people with disabilities. She obtained her bachelor s degree in occupational therapy from the Medical College of Virginia in 1986 and received her certified driving instructor qualification in 1987 from Virginia Commonwealth University. Since that time, she has been committed to training people to operate motor vehicles safely and efficiently. She received her CDRS credentials as a charter member in Deena received the ADED Certificate of Professional Recognition in 1990, and she was recognized with the 1997 Scholar Award from ADED. She received the ADED Achievement Award in Deena has also authored four books and numerous publications on driver rehabilitation and is a frequent presenter at conferences on driver training. She served on the ADED Board of Directors for 3 years and on the board of the Aging Council for the National Department of Transportation and completed research with the National Highway Traffic Safety Association. Betty MacDonald, BS, OTR, CDRS, received her bachelor s degree in occupational therapy from the University of Puget Sound in Tacoma, Washington. She worked as an occupational therapist for approximately 10 years before becoming involved in driver rehabilitation services, where she has worked for approximately 15 years. Since 1998, Betty has been operating her own driver rehabilitation business in Colorado. She has been a member of ADED since 1989 and has served on its Board of Directors. She is actively involved in the Colorado chapter of ADED. Betty has provided a variety of in-service workshops and presentations throughout her career in driver rehabilitation. Linda McQuistion, PhD, PE, CPE, has served as the rehabilitation engineer for the Ohio Rehabilitation Services Commission since As such, she coordinates the driver rehabilitation and vehicle modification programs. She was the founding president (1989) and 2001 president of the Ohio Rehabilitation Technology Association. For 9 years, Linda served on the Board of Directors of the NMEDA. She is an associate editor for Ergonomics in Design, an applied journal of the Human Factors and Ergonomics Society. In 1997 and 2002, she received the NMEDA President s Award, and in 1998, she was presented with the Board of Directors Award. Linda has been designated as an EXEMPLAR Woman in Science and Engineering by the Ohio Academy of Science. She holds a professional engineer s license and is a certified professional ergonomist. Since 2002, Linda has served on the Board of Directors for ADED. Vince Paniak, B Bus., Exec. MBA, Diploma PA, Diploma HS, CSSE, is a native of rural Canada and was educated in Edmonton, Alberta, where he received a degree in business, a diploma in health and safety, and a master's degree in advanced management. His background includes management of labor-dispute resolution processes and workers health and safety, and he has served as operations director for the CAA in Alberta (the Canadian arm of the AAA). There he operated the largest driving school in North America from 1994 to The school s unique programs 30 ADED 2009