Seeing the medical campus through the OT lens

Environmental barriers impact an individual’s ability to conduct daily life. Knowing there are obstacles ahead can truly impact a person’s willingness and ability to participate.

“It comes down to a quality of life issue. Someone with a mobility, vision or hearing impairment shouldn’t have to work so hard navigating obstacles just to get to where they want to go that they can’t enjoy an activity or fully participate in the community,” explains Jessica Dashner, OTD, OTR/L, who teaches the Environmental Factors Facilitating Performance and Participation class to first-year students. The two-semester course gives students an in-depth understanding of the psychological, cognitive, social, political, physical and cultural elements of the environment that influence occupational performance, participation and health. Assessment and intervention strategies that promote health and maximize participation in daily activities are examined in home, school, workplace and other community settings.

During the course’s second semester, Dashner gives students the opportunity to practice and demonstrate the skills acquired in the classroom out in the community through group consultation projects. Students divide into smaller groups and venture out in the community to conduct assessments to determine accessibility and usability around the greater St. Louis area. Each group has a mentor from the Program in Occupational Therapy that facilitates the groups learning. This year, Carla Walker OTD, OTR/L, ATP, and Kim Walker OTD, OTR/L, ATP, were each involved in working with two groups.

“Every year, I have a group of students do a playground accessibility project. I also have a group of students come up with their own building or environmental themes to assess. This year, they wanted to examine the accessibility of local coffee shops,” explains Dashner. “These hands-on activities take students through the process of identifying a problem in the community and deciding how best to address it. They determine which assessments to use and how to administer them, what equipment is needed and if they need additional training before assessing the spaces. It helps them learn to interact with community partners, business owners, architects and other disciplines to improve safety, mobility and ultimately participation.”

One of the community partners the students work with each summer is on the medical campus. The Washington University School of Medicine (WUSM) Facilities department has projects for the students to assess such as new construction, common areas, streets, signage and sidewalks. The relationship began several years ago when faculty member Susy Stark, PhD, OTR/L, FAOTA, served on an ADA committee with Ron Olech, senior project engineering manager. This past summer, the students were asked to examine the accessibility of the newly-opened Scott McKinley Research Building and sidewalks on the medical school campus.

The Scott McKinley Research Building project was a continuation of the assessments conducted the previous year when the building was still under construction. Students examined last year’s recommendations to determine if they were implemented and provided new, additional recommendations to improve the building’s usability beyond the ADA Standards for Accessible Design. The group utilized the Community Health Environment Checklists (CHEC), which examines the physical and social environment, including features important to persons with disabilities. The CHEC answers the question, “Can a person with a disability get in, participate and leave?” The assessment is divided into multiple sections to determine the building’s usability for those with mobility, vision and hearing impairments.

Prior to their visit, the students met with Christner architect Pavel Ivanchuk, who worked on the building’s design. Lauren Leonard, senior project engineering manager, gave the group a guided tour of the building and answered questions they had prior to their assessments. “It was a great experience to assess and explore the McKinley Building while keeping those who may have a disability in mind. As occupational therapy students, we are trained to see how specific building designs and structures can affect a person’s ability to function while at their workplace, or while visiting a building,” says Caroline Hathaway, MSOT/S ’17. “It was great to put all that we had learned about how environmental factors can facilitate performance and participation in the daily lives of others into a real world context.”

The group assigned to sidewalk assessment met with Allan Miller, project manager, civil and landscape, to gather information regarding budgeting concerns, plans that have already been implemented, and the specific interests of WUSM regarding sidewalk access and aesthetics. The students measured the angles of curb cut slopes and the widths of sidewalk cracks and upheavals, and took photos of various environmental hazards. After comparing their data with the ADA Accessibility Guidelines, students used a wheelchair to test out the sidewalks themselves.

“We knew going in that numbers indicating accessibility and the experience of accessibility are two entirely different things,” explains Anne Murphy-Hagen, OTD/S ’18, who found navigating the sidewalks in a manual wheelchair through certain spots challenging. “It kind of felt like a sensory overload. I had to concentrate on all the variables in front of me—the sidewalk terrain, whether I would be able to fit through the spaces between the light post and the fence, etc. It made it difficult to scan the blocks ahead for hazards. The result was I ended up finding myself in situations that would have been best avoided.”

Both groups presented their findings to Dashner and to Steve Sobo, PE, FMP, SFP, director of capital projects for WUSM. The information students provide to Sobo and his team are incorporated not only into current projects, but into clear guidelines for the design standards of WUSM buildings moving forward. The information is also used to enhance way-finding strategies, updates to interior and exterior signage guidelines and modifications to the School of Medicine’s public realm standards. The partnership demonstrates how such collaborations with occupational therapy can be mutually beneficial to the stakeholders and the community as a whole.

“We have benefited greatly from working with the OT students on these assessments. They also provide orientation to my staff on universal design guidelines. This included hands-on opportunities in operating wheelchairs and understanding what it is like to have visual or hearing impairments and trying to navigate our campus,” shares Sobo. “Safety and mobility are top priorities and we really appreciate the support we receive from these annual surveys of our campus.”