Understanding a Client’s Spatial Requirements in Occupational Therapy

Posted: 22nd May 2015

In the past 10 years, all across the UK statutory services have been subjected to a string of restructures and workforce realignment. This has brought immense challenges to the ground-floor staff who have the actual job of meeting the public, assessing their needs and making recommendations to help.

Despite the COTs Position Statement in 2012, Occupational Therapy (OT) services have continued to have their importance overlooked at a strategic level.

Why has this happened? It appears there has been a domino effect on the OTs role, which has seen them stripped of certain key tasks, thus making fundamental, widespread changes to the tasks they undertake. For example, Home Improvement Agencies (HIA) are requesting OTs to not to submit scaled drawings with their Disabled Facilities Grant (DFG) referral. If we work backwards a little, the impact of this is that OTs may omit vital information regarding their client that could be the difference between making a successful adaptation or a publically-funded waste of money.

HIAs provide drawings for OTs to appraise based on the grant criteria and a literal description of the needs of the housing occupant rather than a pictorial description. The drawings are consistently constructed straight from design guidance literature such as BS8300 (2009): Design of buildings and their approaches to meet the needs of disabled people. Code of practice or Part M or K of the building regulations and this is often not in the best interest of the service user.

Have you ever tried to turn a self-propelling wheelchair in a 1500mm turning circle? Have you ever tried self-propelling up a 1:12 ramp? Have you ever tried turning 90 degrees through an 840mm into a bathroom and turn round to shut the door? These are typical examples of the types of design features presented back to OTs for their approval. And, if you haven’t found out whether your service user can do these things, it’s likely that you’ll think it’s going to be OK because it says so in a book.

When you work with your client and actually measure their turning circles then for adults in standard, self-propelling wheelchairs their actual turning circle can be around 1680mm – 1890mm. This is considerably larger than the 1500mm a designer will allow by default, and is supported by the research carried out by the Northern Housing Executive.

An OT must measure their client. It is vitally important, as having a good understanding of their spatial requirements helps the OT to inform the architect drawing their proposals what real dimensions are needed to make an adaptation work rather than the generic guidance they refer to.

The OT should consider making it part of their initial assessment to take time to measure their client’s spatial data. By knowing from the beginning how much activity space they need for all their activities of daily living, the OT can make precise client-centred recommendations.

Knowing the client’s spatial needs will allow an OT to:

• Offer a client-centred recommendation
• Be precise in their drawing appraisal
• Clinically reason larger adaptations if their needs cannot be met within the existing space
• Offer insight into the likely future needs of their service user so that they can be built in to the proposal saving time, money and disruption to the occupant.
• Make a positive contribution on saving time and money, ensuring the adaptation will work first time.
• Have good background knowledge to help the service user consider the benefits of a new property if they have to relocate.
• Allow the service user to build up a trust with them and feel confident that the OT is advocating for them.

There are some interesting times ahead. The recent introduction of The Care Act 2014, which comes into force on the 1st April 2015 should bring about some help in clinically reasoning future-proof recommendations. It implies a shift from reacting to needs that was so prevalent in the rescinded Chronically Sick and Disabled Persons Act 1970 to preventing needs to engage with services.

There are some more contemporary design guidelines to help us argue for greater space such as the Northern Ireland Adaptations Design Communication toolkit. This recent document has been the result of extensive user trials and for the first time offers a matrix of minimum dimensions for a range of abilities in differently used rooms within a house.

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