Post-occupancy evaluation: An environment-behaviour technique for assessing the built environment

Abstract

This paper reviews the development, structure and process of post-occupancy evaluation (POE) as an environment-behaviour approach to assessing built environments of all sizes and types. It illustrates the use of POEs with three examples from the Health Care sector: The Canadian Hospital Evaluation Program, the Weiss Institute, and 18 independent-living apartment units. A comparison is made between POEs and the approach currently used by occupational therapy (OT) for environmental assessments. Recommendations suggest that OT's approach could be extended and strengthened through 1) incorporating POE methods and existing data from environment-behaviour studies; 2) the use of standard assessment procedures and well-validated measures; and 3) the development of a data bank on OT environmental assessments.

Full text

CJOT • VOLUME 58 • NO 4
BARBARA ACHESON COOPER • SHERRY AHRENTZEN •
BETTY RISTEEN HASSELKUS
Post-occupancy evaluation:
An environment-behaviour
technique for assessing the built
environment
ABSTRACT
This paper reviews the development, structure and process
of post-occupancy evaluation (POE) as an environment-behaviour approach
to assessing built environments of all sizes and types. It illustrates the use of
POEs with three examples from the Health Care sector: The Canadian Hospital
Evaluation Program, the Weiss Institute, and
18
independent-living apartment
units. A comparison is made between POEs and the approach currently used
by occupational therapy (OT) for environmental assessments. Recommenda-
tions suggest that OT's approach could be extended and strengthened
through 1) incorporating POE methods and existing data from environment-
behaviour studies; 2) the use of standard assessment procedures and well-
validated measures; and 3) the development of a data bank on OT environ-
mental assessments.
KEY WORDS
Assessment process,
occupational therapy
Data collection
Environment, physical
Barbara Acheson Cooper,
M.H.Sc., Dip. P.O.T., (OT)C, is As-
sociate Professor, Associate Dean
and Director of the School of Occu-
pational Therapy and Physiotherapy
at McMaster University, 1200 Main
Street West, Hamilton, Ontario,
L8N 3Z5.
Sher
ry
Ahrentzen,
Ph.D., is
Associate Professor and Chair of the
Ph.D. Program in Architecture at the
School of Architecture and Urban
Planning, University of Wisconsin-
Milwaukee, Milwaukee.
Betty Risteen Hasselkus,
Ph.D., OTR, is Assistant Professor
and Coordinator of the Occupational
Therapy Program in the Department
of Therapeutic Science, University of
Wisconsin-Madison, Madison.
RÉSUMÉ

Cette étude procède à la révision de l'élaboration, de la
structure et du processus de l'évaluation post-professionnelle en tant
qu'approche axée sur l'environnement et le comportement pour l'évaluation
des environnements construits de toutes tailles et de tous types. Elle illustre
l'utilisation de l'évaluation post-professionnelle à l'aide de trois exemples
issus du milieu de la santé: le Programme d'évaluation des hôpitaux
canadiens, le Weiss Institute et 18 unités de logement autonomes. Une
comparaison est établie entre les évaluations post-professionnelles et l'approche
habituellement utilisée en ergothérapie pour les évaluations de l'environnement.
Les recommandations qui s'ensuivent suggèrent que l'approche de
l'ergothérapie pourrait être étendue et renforcée par 1) l'incorporation des
méthodes de l'évaluation post-professionnelle et des données existantes
provenant des études sur l'environnement et le comportement; 2) l'utilisation
de procédures d'évaluation standardisées et de mesures bien validées; et
3) l'élaboration d'une banque de données sur les évaluations environnementales
en ergothérapie.
OCTOBER 1991 • 181

CJOT • VOLUME 58 • NO 4
1
Occupational therapists (OTs) are frequently called
upon to assess the functional fit of housing for clients
with residual or temporary disabilities. We can expect
this role to expand in the future in response to the
needs of various emerging societal trends, such as the
independent living movement, educational
mainstreaming and the large increase in the number of
elderly people residing in the community. These
individuals will not only require barrier-free residences
that are responsive to their needs, but will also need
public and community facilities that enable them to
function in situations related to employment, recre-
ation, education and other necessary services (Taira,
1984). The assessments presently used by OTs, prima-
rily to evaluate residential environments, will need to
be extended and modified to suit the requirements of
assessing community buildings and facilities. Of inter-
est, therefore, is a technique called post-occupancy
evaluation (POE) which has been developed by archi-
tects and social scientists with a shared interest in
human behaviour and the physical environment. Post-
occupancy evaluations are used to assess whether
buildings are fulfilling their functional purpose.
This paper describes and discusses POEs, using
three health related examples to illustrate the scope of
the technique. The similarities and differences between
POEs and OT assessments are highlighted. The paper
concludes with some suggestions for incorporating the
strengths of the POE approach into the OT method.
What are Post-Occupancy Evaluations?
Post-occupancy evaluations in architecture are con-
cerned with social and behavioural issues as opposed
to aesthetic issues (Wener, 1989). They compare actual
building performance with explicitly stated human
performance needs. Variables such as task perfor-
mance, privacy, communication, safety and thermal
comfort may be considered. Evaluations are con-
ducted by an individual or team on site, following a
specified format, which can range from a simple to
complex investigation of concerns. Performance is
typically measured on three dimensions:
technical,
functional
and
behavioural
(Preiser, Rabinowitz &
White, 1988).
The first measurement category,
technical,
evalu-
ates environmental aspects such as health hazards, fire
safety, and the heating and cooling systems of the
building. The identification of problems in this area is
of concern to all individuals and may reasonably fall
within the domain of OT for active intervention.
However, the second, which addresses the user's
ability to
function
effectively and efficiently in the
building or community, is perhaps more directly
related to OT interests and responsibilities.
Function
refers here to performance in the areas of self care,
productivity and leisure and therefore has the same
meaning in the environment-behaviour literature as it
does in OT (Department of National Health and
Welfare & Canadian Association of Occupational
Therapists (DNHW & CAOT), 1983). The third per-
formance criterion,
behaviour,
is also critically relevant
to OT. This refers to psychological and social aspects
of user satisfaction and to the general well-being of
building inhabitants (Preiser et al, 1988). It parallels the
Model of Occupational Performance's depiction of the
individual as a composite of spiritual, physical, mental
and sociocultural influences (DNHW & CAOT, 1983).
The three facets of POE therefore address environment-
behaviour (E-B) issues directly related to the clinical
practice of OT.
Post-occupancy evaluations have a history of ap-
proximately 25 years. Early POEs were mostly conducted
by academic researchers who investigated select small-
scale behavioural issues in institutional settings, such
as Wheeler's studies on patterns of social interaction in
college dormitories (discussed in Wheeler, 1985).
Results of such evaluations often provided information
for the subsequent design of similar facilities. During
the seventies, the scope, rigor and number of POEs
conducted increased dramatically. Contracts were
usually government-funded and were characterized as
being large and institution-based; multimethod ap-
proaches were developed; and the links between the
built environment and behaviour were firmly established
(for example,
an
association between increased crime
rates and ce
rt
ain environmental features was demon-
strated by Newman, 1972). During the decade of the
70's POEs were gradually acknowledged as a practical
technique. By the 1980's, POEs were routinely used by
government bodies and began to be adopted by the
private sector (e.g. hotels, retailing) which was attracted
to this method of assessment for economic reasons.
Funding from government sources for academic re-
search is now diminishing, and Rabinowitz (1989)
suggests that the shift towards commissions from the
private sector, which is driven by pragmatic self-
interest rather than by academic concerns, may have a
steering effect on the
ty
pe of POEs conducted in the
future. That is, POEs will likely focus more on issues
that have economic consequences than on the devel-
opment of theory.
POST-OCCUPANCY EVALUATION:
THE PROCESS
Some authors, for example, Zeisel (1989), are critical of
current POE methods and call for a greater sharing of
information and standardization of approach and
methods. Others, such as Rabinowitz (1989), consider
the present format to be stable, reliable and replicable,
and indeed, most of the publications on POE seems to
suppo
rt
this second view. A process approach, such as
182 • OCTOBRE 1991

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PHASE 2
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CJOT • VOLUME 58 • NO 4
Figure 1
The Post-Occupancy Evaluation Model of Preiser, Rabinowitz and White
The post-occupancy model
of
Preiser, Rabinowitz and White. Reprinted with the
permission of
Van Nostrand Reinhold, New York,
from Post-occupancy Evaluation by Preiser, Rabinowitz and White, 1988, p. 54.
the one clearly delineated by Preiser et al (1988), is
most frequently observed, and this model is described
briefly here.
The model structures POEs into three phases:
planning, conducting and application (Figure 1). Be-
fore a POE is undertaken, its purpose must be clearly
stated and justified. This will determine the depth and
cost of the exploration, which in turn determines the
type of
POE:
Indicative, Investigative,
or
Diagnostic.
Post
-
occupancy Evaluations: Indicative Type
The
Indicative
form of POE attempts to identify the
major functional failures and successes of the building
in a general manner. That is, the physical qualities of
the setting which foster or impede desired or necesssary
behaviours in occupants are noted; appropriate and
unwanted behaviours on the part of residents are
recognized. An Indicative POE is conducted in a sho
rt
period of time (2-16 hours), usually by one person, and
its effectiveness is primarily dependent on the expe-
rience and insight of the individual who carries out the
assessment. The following format is observed:
1)
a review of archival material related to the history,
utilization and performance of the building is con-
ducted prior to collecting data;
2)
data are gathered on performance issues primarily
through the use of standard questionnaires;
3)
a walk-through of the building is done; photo-
graphs, measurements etc. may be taken;
4)
interviews are held with a few key people;
5)
a
brief written repo
rt
and recommendations are
submitted.
By means of this basic, cross-sectional evaluation,
the presence, frequency and location of factors that
support or impede activities are identified and compared
to the expert's knowledge.
Simple solutions or the need for further investiga-
tion are then suggested.
Post
-
occupancy Evaluations: Investigative Type
Investigative
POEs follow the same basic procedure as
the Indicative POEs but undertake each step more
extensively. They require an estimated 160-240 staff
hours and the assistance of suppo
rt
staff service to
conduct. Unbiased criteria for building performance
are developed by means of a literature review and
comparisons with similar facilities. This evaluation
covers more topics in greater detail and with greater
reliability and additionally, allows performance to be
monitored over time.
Post
-
occupancy Evaluations: Diagnostic Type
The most sophisticated form of POE,
Diagnostic,
may
take from several months to a year to conduct, and
employs a team of researchers and suppo
rt
staff. Again
the basic structure is similar to the less detailed POEs,
OCTOBER 1991 • 183

CJOT ® VOLUME 58 ® NO 4
but these evaluation studies differ in three important
ways: 1) they employ triangulation or multileveled
strategies for gathering data on numerous variables; 2)
they use basic scientific research designs; and 3) they
employ representative samples which allow the results
to be generalized to similar buildings and situations.
On completion of the Diagnostic POE, a formal report
which interprets the data and suggests strategies for
change is issued, and briefing sessions are held to
discuss the implementation of these (Preiser et al,
1989). The aim is to improve not only the particular
facility, but to advance the state of the art for all
buildings of that type, and to provide information that
can be applied in similar
buildings.
Diagnostic POEs
are costly ventures and are only warranted under
circumstances when the anticipated long-term gains
seem to outweigh the expense.
Of the three, the Indicative POEs describe a process
very similar to the home assessments now undertaken
by OTs (Cooper, Cohen & Hasselkus, 1991). However
other similarities also exist. For example, the literature
reviews incorporated into the higher-level POEs might
also be undertaken in certain circumstances prior to
conducting an OT environmental assessment. Trian-
gulation may also be employed by an OT: it is not
unusual for a therapist to assess the same function from
more than one perspective. While OTs do not usually
conduct evaluations on the scale of the Investigative
and Diagnostic POEs, it is not unreasonable to assume
that this could change (Cooper, Cohen & Hasselkus,
1991). Because of their professional skills and knowl-
edge, OTs would be an asset on the evaluating team of
these more extensive, multidisciplinary, evaluation
procedures, as the examples given later in this paper
illustrate.
POST-OCCUPANCY EVALUATIONS:
ISSUES FOR DISCUSSION
Two current debates surrounding the use of POEs are
of interest to OT. The first concerns the use of client
feedback. Many architects consider that the opinions
of owners and residents regarding the impact of
buildings on behaviour are a necessary component for
improving design. Others, however, claim that client
feedback is too difficult to measure objectively, and
that it restricts creativity. There is also a very real fear
that such evaluations may foster litigation should the
building be deemed inadequate in any way (Becker,
1989). Occupational therapists should be aware of
these professional sensitivities.
In spite of these potential problems, the use of
collaboration is gaining acceptance (Zimring, 1987). In
New Zealand, for example, participatory methods
have been integrated into all standard government
POEs. Zimring (1987) notes that pa
rt
icipation by the
client appears to increase the final utility of the POE.
Occupational therapists consider it essential and fun-
damental to clinical practice to include client input into
the design of the environment (DNHW & CAOT, 1983).
This is well illustrated by Project Open House (Colvin
& Korn, 1984), perhaps the largest plan in the United
States to modify home environments for people with
disabilities.
The second debate centres on the question of
whether the 'POE is a diagnostic or a research tool.
Becker (1989) considers it a diagnostic tool and
distinguishes between the interests and skills of ar-
chitects and those of E-B researchers. He believes that
the adoption of the more rigorous research standards
of the E-B,field alienates the design community. Becker
feels strongly that POEs should only
generate
research,
and thinks that as a diagnostic tool, they are best used
by practitioners themselves as quick, simple, small-
scale investigations which can provide feedback for
future design and provide direction for the more
stringent studies of E-B researchers.
Occupational therapists currently view and use
home assessments in the diagnostic manner described
by Becker (1989), that is, for quick investigations of
buildings or home settings to determine whether
individual clients can function appropriately in them,
and to make recommendations for necessary modifi-
cations. In this area of clinical practice, there has been
little attempt to use reliable, validated measures or to
employ scientific rigor (Cooper, Cohen, & Hasselkus,
1991). Generalizability has not been considered nec-
essary. The additional use of POEs or environmental
assessments as a research tool, therefore, suggests a
supplementary and impo
rt
ant consideration for our
practice base. Zimring (1987) identifies three research
thrusts for POEs in the E-B field that are of interest.
These are: 1) to gather and represent the views of users;
2) to explore conceptual issues; and 3) to influence
future decision making. Occupational therapy might
want to add a fourth: to influence future clinical
practice. The POE methods discussed in some detail by
Zimring (1987) are also of interest to OT. These include
methods that currently form part of the OT
armamentorium, such as inte
rv
iews, obse
rv
ation and
assessment of physical settings, but expand the list in
a most useful manner, for example, the use of behaviour
mapping and photography.
Wener (1989) considers that there are two types of
research POEs:
comparative
and
generative.
The first
kind,
comparative
POEs, is used to assess the status of
a building and compare this to a propotype ac-
knowledged for excellence. This approach is particularly
useful when evaluating institutions, for example, nursing
homes, and for the development and improvement of
the standards of such facilities. Standardized, well-
validated instruments, like the Multiphasic Evaluation
184
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•
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Assessment Procedure (MEAP)(Lemke, Moos, Gauvain,
& Mehren, 1979), are used in these instances. In
comparative POE research, both case studies and
hypothesis testing may be undertaken.
Generative
POEs
;
which primarily foster the ad-
vancement of new design ideas, are best served by the
use of open-ended qualitative techniques. The rich
data collected through these methods are essential for
the development of relevant hypotheses and theory.
Both research thrusts are useful; each has limitations.
For example, comparative POE studies are seldom able
to use randomization when examining causal questions,
and the use of non-equivalent control-group designs is
likely [See Marans & Ahrentzen (1987) for a discussion
on this]. When controls of any kind are unavailable,
impractical, or undesirable, case study research must
be used. Case studies are used in both comparative and
generative studies and are often criticized for lacking
rigour. However, they provide the means for studying
both unique and standardized building examples and
for developing explanatory theories on the complex
subject of human-environment interaction [For an
indepth discussion on this approach, the reader is
referred to Wener (1989)]. Wener also comments on
the need to consider time as a critical variable in both
types of research. Clearly most OT home assessments
are generative in nature, being primarily concerned
with the individual aspects of the the human-envi-
ronment interaction, but they presently stop sho
rt
of
theory development.
HEALTH CARE 'EXAMPLES
A sample of three POE's conducted in the health care
sector has been selected to illustrate the use of this
method of evaluation in areas familiar to OT. These
examples include the evaluation of hospitals, of a
nursing home, and of independent-living apartment
units.
The Canadian Hospital Evaluation
Programme
Perhaps the largest scale and most comprehensive use
of POEs in the area of health care is the current Hospital
POE Program instituted by the Federal Department of
Health and Welfare in Canada in conjunction with the
provincial health authorities (Zeisel, 1989). This
programme has established a standard format for
evaluating Canadian hospitals and created a national
data base to be used for setting priorities and guiding
future design. These diagnostic POEs consist of four
well-defined phases similar to those described by
Preiser and colleagues (1988). The first of these,
briefing,
provides relevant background information on
the facility prior to making a site visit. This step is
followed by two sequential site visits which form the
profile
and the
diagnostic
phases. As the names imply,
the first is directed
at
identifying
the
performance
strengths and weaknesses of the facility, while the
second focuses on investigating and making recom-
mendations about issues deemed critical. The fourth
phase,
database,
allows comparisons with other na-
tional hospital using the information collected in
phases two
and
three. The purpose, for which the
hospital facilities exist is used to formulate the general
and critical performance standards for the institution.
These then guide and drive data gathering and analy-
sis. Three factors allow comparisons to be made across
these studies: the use of a common theoretical base,
shared objectives and reliable, valid instruments of
measure (Zeisel, 1989).
During the initial development of the Hospital POE
Programme, eight Canadian hospitals were evaluated.
Three more POEs were conducted during the first year
and a National POE Programme is now in place. The
primary purpose of the resultant data bank will be to
provide rapid access to information for hospital de-
signers and thereby ensure that future hospitals are
constructed in a sensitive and flexible manner (Zeisel,
1989). This reciprocals approach, which includes and
values the views of all health care professionals, staff
and consumers, holds promise for improving the
delivery of health care in Canada.
The Weiss Institute
Post-occupancy evaluations have also been modified
for use in relocation studies, such as
the
move of 350
severely impaired elderly residents of the Weiss Institute
in Philadelphia from a traditional nursing home to an
environment specifically designed' to promote and
preserve function (Lawton, Fulcomer,& Kleban, 1984).
Programme goals were guided by a literature review
and interviews with care-givers _ and administrative
staff, families and patients 'capable of responding.
Changes in mental status
;
in physical self-maintenance
and in behaviours related to orientation, social interac-
tion, and participation in activities were noted at two
points in time, 12 months prior and seven months after
the move. Measures included the obse
rv
ation and
mapping of different behaviour patterns using estab-
lished E-B methods, validated tests of mental status and
physical self maintenance of patients, and the record-
ing of opinions related to the function of the building
itself. While the expected patient decline over time was
observed, unexpected improvements such as a de-
crease in pathology were also noted. As well, the
visiting rate of families doubled during the post-move
period.
This study is of particular interest to OTs because it
expands upon their traditional focus on activities of
daily living, suggests additional methods of behaviourial
obse
rv
ation, and demonstrates the importance of the
OCTOBER 1991 • 185

CJOT • VOLUME 58 • NO 4
built environment on behaviourial outcomes consid-
ered meaningful in clinical practice. The scope of this
relocation study identifies it as a Diagnostic POE with
a team approach. Occupational therapists, skilled in
interviewing and functional assessment and familiar
with hospital settings and patient concerns, would
make good members of these larger evaluation teams.
However, it is not necessary to wait for large scale
projects to occur; OTs could take advantage of natu-
rally occurring moves within institutions and undertake
more limited studies to explore questions such as the
interaction between patient function and relocation to
new ward environments.
Independent Living Units
An Investigative POE was conducted by Reizenstein
and Ostrander (1981) on 18 apartment units specially
designed for individuals with quadriplegia. This inves-
tigation, conducted by three researchers, took a total of
eight single working days and included inte
rv
iews
with attendants and residents, the examination of
archival material, a walk-through of the premises,
obse
rv
ation and photography. The data from this study
were then submitted to the Department of Housing
and Urban Development (HUD) to provide informa-
tion for modifying specifications for future HUD spon-
sored apartments.
Of interest are the recommendations reported,
which might just as easily have been made by an OT
team as by the social scientists! These included the
identification of safety needs (back-up emergency
power sources for call systems); privacy needs (visual
screens required for bedroom and bathroom areas);
issues of mobility (the lack of manoeuvrability of
electric wheel chairs); issues of function (the need for
adjustable table tops in the kitchen and living room);
and issues of access (the need for automatic doors at
the main entrance). In all, the changes recommended
were directed at providing the resident with greater
control over the environment and at facilitating inde-
pendent living. Had this POE been conducted on one
unit rather than on 18, it might well have been done by
an OT and called a home assessment.
It is clear that in this particular POE example, the
boundaries between OT and the E-B team have blurred
and meshed. Not only is the smaller scope more closely
related to our clinical practice, but the focus and
purpose falls into the area of OT as we
ll
. However, this
overlap does not mean that the two professions are
identical or encroaching into each other's domain.
Rather, it indicates that our interests are similar and
related, and reinforces the idea that each could learn
from the other. Besides the more systematic approach
to environmental assessment espoused by E-B, the
critical difference between the two is expressed by
how
the
information is used
afterit
has been collected.
For the social scientist and architect, it will be to
contribute to developing better physical environments
for people; for the OT clinician, it will be used as an
information base from which to develop and imple-
ment an appropriate intervention for the individual
resident of the unit.
OCCUPATIONAL THERAPY AND
POST-OCCUPANCY EVALUATIONS
What can OT learn from this E-B approach to environ-
mental assessments? Perhaps it is best to view the
discussion on POE as an analogue. Environment-
Behaviour studies focus on investigating the built
environment for the purpose of being able to explain
and predict the factors that provide environments
responsive to human performance (or conversely,
those which are non-responsive and even detrimen-
tal). As health care professionals, occupational thera-
pists are also interested in providing a responsive
environment for people, but traditionally approach
this from the perspective of disability, the individual,
and home. New demands, such as the integration of
disabled children in schools and the independent
living movement (Cooper & Hasselkus, in press), now
require us to extend that focus to groups of people, and
to the community at large. The narrow focus on
disability in OT is also being broadened to include
prevention and active promotion of health (Podborsky
et al., 1987; Spasoff et al., 1988). At this point the
boundaries and analogue break down, and the objec-
tives of the two fields regarding environmental as-
sessments become almost identical. What does remain
as a critical difference between the two fields is the
role of the professional
after
the environmental as-
sessment has been completed.
Environment-Behaviour researchers have developed
a common language and format for evaluating build-
ings and behaviour. This approach is the product of 25
years of debate, discussion and research, and its
standardized format now permits more accurate
comparisons across buildings and facilities of different
ty
pes and sizes, and across research studies. As well,
data banks have been developed which facilitate the
dissemination of information gained from reported
POEs. In addition to brief case studies that offer easily
understood feedback to practitioners, more stringent
Diagnostic POEs have generated knowledge and helped
to develop theory. Because POE is a multidisciplinary
approach, and because at least on one level it so
closely mirrors our existing practice, we might well
consider adopting a similar process model. We should
also take advantage of the information that is already
available from existing databanks and not feel the need
to generate this independently. The mechanism of
conceptualizing environmental assessments broadly
186 • OCTOBRE 1991

CJOT • VOLUME 58 • NO 4
would allow OT assessments to fit into a community
continuum rather than be placed in a disability model
that considers mostly single case needs.
However, one major concern remains: The issue of
OT assessments. Occupational therapy currently lacks
agreement on the environmental assessments used in
practice, and idiosyncratic, situation-specific approaches
are the norm. These in fact are advocated as the
preferred way to accommodate individual patient
variables such as economic and cultural differences
(Levine, 1988). Two questions arise: 1) can OT as-
sessments and process be standardized without for-
feiting professional integrity and concern for individual
needs; and 2) what instruments do we currently have
available to measure function and the environment?
All POEs are basically case studies. Even those that
form part of large-scaled projects, such as the Canadian
Hospital Evaluation Programme, acknowledge the
individual differences inherent in the institutions while
yet standardizing the evaluation process. Occupational
therapy assessments could do the same. Issues of
concern to particular cases could still be noted and
included in the intervention which always remains
individualized. Therefore, we argue that assessments
and process could be standardized in OT without
compromising client care.
The question of measurement is more difficult. A
search of the literature located only two publications
that described OT assessments which might be suitable
for this purpose. The first was the form developed in
1981 by OTs for use in a multidisciplinary project,
Project Open House (POH). This was used as an
instrument to evaluate the homes and function of
disabled residents of inner-city New York prior to
making environmental modifications directed at en-
hancing function and preventing institutionalization
(Colvin
&
Korn, 1984). Although the authors state that
an external evaluation of the project was done, it is
difficult to ascertain the effectiveness of the interven-
tion. No instrument reliability or validity testing on the
instrument is reported. However, a recent follow-up
study on this project reports on the perceptions of a
stratified sample of POH clients and claims that housing
modifications are one of five factors which explain 54%
of the variance of productivity of these individuals
(Dunn, 1990).
A second even more promising assessment has
been issued recently as a guide to making home
adaptations for elderly people (Canada Housing and
Mortgage Corporation, 1989). This extensive evalua-
tion form was developed with the help of expe
rt
s from
both the field of design and occupational therapy.
Reliability and pretesting of the instrument, which was
supported by the Department of Community Health of
the Montreal General Hospital, has now been com-
pleted. The assessment is to be administered by an OT
and is presently being tested on a sample of
400
frail
elderly. The standardization and the validation of OT
instruments such as these, as well as of the assessment
processes itself, would foster the comparison of OT
intervention results and provide a consistent format for
the reporting of case histories and other studies.
RECOMMENDATIONS
How can we apply some of the ideas that E-B Studies
have developed over the past 25 years? The ideas
discussed above are consolidated here as recommen-
dations to be considered:
1)
OT should be aware of and build upon existing data
bases in other fields that may be relevant to its
concerns.
2)
OT should consider the development of a standard
process model for conducting environmental as-
sessments. This model should be suitable for all
types of buildings and settings and for the assess-
ment of the functional needs of both individuals and
groups. One such model has been discussed in this
paper.
3)
OT must validate its environmental assessments.
Two existing instruments, one of which has been
validated, have been discussed,
4)
OT should consider the use of environmental as-
sessments at two levels: a) as precursors to clinical
intervention and b) as research:
5)
OT should develop a data bank for the dissemina-
tion of information on accessibility and other as-
pects of environmental assessment which have been
gained from case studies and other research.
The literature reviewed on POEs suggests a number
of factors which could be of value to OT and, if
incorporated, help develop and strengthen our clinical
base. These ideas are presented here not as directives,
but as statements to be debated and considered by the
profession.
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ACKNOWLEDGEMENTS
Barbara Acheson Cooper wishes to acknowledge the
support of the Canadian Occupational Therapy Foun-
dation, the Universi
ty
of Wisconsin-Milwaukee and the
Social Sciences and Humanities Research Foundation
of Canada during the preparation of this article.
188 ® OCTOBRE 1991