OccupationalTherapy in

HousingBuilding on Firm Foundations

Edited by

SYLVIA CLUTTON Dip MCS, Dip COT, BCA, DASEd, Certed Ed

JANI GRISBROOKE Dip COT, BA(Hons), MScUniversity of Southampton

and

SUE PENGELLY Dip COT, BA(Hons), MBA, PGCE, ILTMUniversity of Cardiff

WW H U R R P U B L I S H E R S

L O N D O N A N D P H I L A D E L P H I A

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Occupational Therapy in HousingBuilding on Firm Foundations

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OccupationalTherapy in

HousingBuilding on Firm Foundations

Edited by

SYLVIA CLUTTON Dip MCS, Dip COT, BCA, DASEd, Certed Ed

JANI GRISBROOKE Dip COT, BA(Hons), MScUniversity of Southampton

and

SUE PENGELLY Dip COT, BA(Hons), MBA, PGCE, ILTMUniversity of Cardiff

WW H U R R P U B L I S H E R S

L O N D O N A N D P H I L A D E L P H I A

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Contents

Contributors viiPreface xi

Chapter 1 1

The theory basesJani Grisbrooke

Chapter 2 21

The assessment processFrances Heywood

Chapter 3 43

The social model and clinical reasoningSue Pengelly

Chapter 4 64

Housing: the user’s perspectiveSally French and John Swain

Chapter 5 83

Conveying information through drawingPeter Ashlee, Sylvia Clutton, Sue Pengelly and Jon Cowderoy

Chapter 6 109

Access standards: evolution of inclusive housingParaig O’Brien

v

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Chapter 7 139

Housing adaptations and community careClare Picking

Chapter 8 166

Ergonomics and housing Carla Benedict, Samantha Pooley and Jani Grisbrooke

Chapter 9 194

Evaluation for service users and service performanceSue Pengelly and Andrew Winfield

Chapter 10 219

Smart technology at homeKathryn McNab

References 240Index 255

Occupational Therapy in Housing: Building on Firm Foundationsvi

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Contributors

Peter Ashlee is an experienced OT in Social Services. He has a back-ground in the building industry and had previous architectural training.Peter is a Fieldwork Educator and is interested in the environmental effecton clients with disability, generously imparting his knowledge of relevanthousing issues to student OTs.

Carla Benedict has worked in the local authority setting for 18 years.During this period, she completed further training in moving and han-dling and ergonomics and was Moving and Handling Specialist OT forHampshire for three years. She is presently a senior practitioner, combin-ing this specialist knowledge with housing adaptation work.

Sylvia Clutton, former Chair of COTSSIH and Vice Chairman of theCouncil of the COT, has worked in general and community health settingsand managed OT services in Social Services. She works as a ConsultantOT and is commissioned to provide medico-legal/judicial review/manualhandling risk assessment training and housing design and redesign.

Jon Cowderoy is an experienced housing liaison officer based in the OTdepartment. He has considerable experience of working with computer-aided design and imparting knowledge to student OTs.

Sally French works as an Associate Lecturer at the Open University andis a freelance researcher and writer. She has a particular interest inDisability Studies and has written and researched widely in this area.

Jani Grisbrooke has worked as an OT in health, local authority and edu-cation. She is currently working as a lecturer in occupational therapy forthe University of Southampton and as a specialist OT in housing betweenHousing and Social Services Departments of Southampton City Council.

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Occupational Therapy in Housing: Building on Firm Foundationsviii

Frances Heywood is a Research Fellow at the School for Policy Studies,University of Bristol, who learnt a user-centred perspective through work-ing for an inner-city residents’ federation. She has researched widely inthe field of adaptations, in partnership with occupational therapists,housing officers and disabled research colleagues.

Kathryn McNab qualified as an OT in 1985. Her first posts were hospitalbased, but the majority of her experience has been gained within localauthority. She is currently a Team Leader with the Health and Social CareTeam, a varied and demanding role including a project to incorporatesmart technology into housing.

Paraig O’Brien (COTSSIH Chair) has a special interest in disability designresearch, completing an MA in this subject at London Guildhall University.He undertook research on assistive technologies in Oxford and morerecently was seconded from the University of Ulster to assist governmentagencies reviewing housing adaptations services in Northern Ireland.

Sue Pengelly qualified as an OT in 1986, following which she worked inhealth before specialising in housing, working in both the Vale ofGlamorgan and Cardiff Social Services. She is currently a Lecturer in occu-pational therapy at Cardiff University.

Clare Picking has worked mainly in Social Services Departments sincequalifying in 1970 and as an independent practitioner for the past fewyears. She completed an MSc in Rehabilitation and Research and has pub-lished work on her thesis about professional roles in home adaptations inthe British Journal of Occupational Therapy.

Samantha Pooley qualified as an OT in 2000. Following postgraduateeducation, her clinical practice has focused on complex moving and han-dling cases. She is now working as a Specialist OT for Hampshire SocialServices. Ergonomic design and suitability of environments for heavierpeople has become a special interest for her as community ‘bariatric’needs increase.

John Swain is Professor of Disability and Inclusion at the University ofNorthumbria. His research interests include the analysis of policy andprofessional practice from the viewpoints and experiences of disabledpeople. He has written and researched widely in this area.

Andrew Winfield has worked in local government for more than twentyyears. He spent six years working in benchmarking with Welsh local gov-ernment focusing on performance measurement and comparison,

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developing practice standards, and training and applying the principles ofperformance management. He has recently taken up a post with TorridgeDistrict Council in north Devon.

Contributors ix

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Preface

This book aims to provide occupational therapists with firm foundationson which to build their understanding and practice in housing work.

It grew out of the need, recognised by the College of OccupationalTherapists’ Specialist Section in Housing (COTSSIH), for undergraduateoccupational therapists and occupational therapists newly moving intohousing to have access to a text which was inspirational and drew togeth-er the various theory bases on which this eclectic aspect of the professionrested. It is part of the mission of the Specialist Section to develop thisarea of occupational therapy and improve outcomes for the users of ourservices. The editors are keen to publish a common approach to applyingthe principles of best practice in housing from an occupational therapyperspective in a socio-political context, where occupational therapists asdesigners understand the reality of the demands of the situation, thediversity of users’ perspectives, building codes and statutory regulatorysystems, and the regulation and inspection of their professional practice.

Designing new-build properties and redesigning properties, or parts ofproperties, as enabling environments in which to live and carry out mean-ingful occupations has been part of the core workload of occupationaltherapists in the UK for a very long time. The therapist generation towhich the editors belong can reach back to learning from the experienceof occupational therapists practising in the 1960s. This is an impressivehistory of practice to draw upon but has mostly been in the form of richpersonal reflection on practice rather than written text.

While some areas of occupational therapy based on medical specialtycan show a very well-boundaried and focused theory and evidence base,work with housing crosses a number of theory domain boundaries. Thecreative interaction of concepts and practices brought together by thesebreaches of discipline boundaries has been part of the joy of working insuch a rapidly developing field.

The characteristic of practice in the field now, as in the 1960s, is that ofa ‘hands on’ approach. Occupational therapists would wish to ‘get on

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Occupational Therapy in Housing: Building on Firm Foundationsxii

with the job’ and find out what would work best by trying it out. Thesepractitioners have also been curious about what related areas – ergonom-ics and construction disciplines, for instance – could offer in the way ofideas and support. Thus a range of theory and concepts has come into usein daily professional practice without a pressing need being felt for pre-senting a coherent account of them to the world. The theories and prac-tices have been passed on from supervisor to student and shared betweeninterested practitioners.

This book is part of the work of COTSSIH aiming to present the theo-ry and evidence base for occupational therapy in housing in a more acces-sible manner for learners and all other interested parties. Having such alively practice base, it is appropriate that a presentation of theory shouldgrow out of that practice. The larger proportion of the authors is thus cur-rently active as practitioner occupational therapists and others are educa-tors and researchers in the field of occupational therapy. Alongside this,academics in social policy, disability issues and managers are represented.Although the content of this book is grounded in the experience of UKpractitioners, the editors believe this situated practice which takesaccount of local culture, social history and legal frameworks will demon-strate principles and approaches applicable to practitioners in othercountries with their own socio-political backgrounds.

The editors hope that this book conveys how challenging and satisfyingsuch a creative endeavour as occupational therapy work in housing canbe. We also hope that our service users find the outcome of those endeav-ours to be just as satisfying.

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CHAPTER 1

The theory bases

Working with housing and people’s homes, housing professionals requirea different background understanding and extension of professionalskills to those used to working with a healthcare team in a hospital or acommunity setting.

In this chapter, the theory bases which underlie what occupationaltherapists do with housing work, why they do it and how they do it willbe examined. The sections of this chapter link to and are introductory tolater chapters which cover occupational therapist practice in the field.

Theory bases identified include:

• socio-political approaches (citizenship, rights, civil rights and socialpolicy, control of the professions);

• occupational therapy approaches (problem-solving, environment as aterm, Reed and Sanderson, person-environment-occupations model,Person-Environment-Occupational Performance Model, occupationalscience);

• construction and design theory bases (ergonomics, building andplanning);

• biomedical/health theory base;• two issues not in themselves theory bases (care management and evi-

dence-based practice).

Introduction

Working with housing means working with a phenomenon which is bothuniversal, since most people in the world live in built accommodation,but which is culturally specific in that techniques, traditions, methods andmaterials for building vary across countries and ethnic groups. The expe-rience of working with housing adaptations as an occupational therapistis also nationally specific since the ways in which adaptations for people

1

JANI GRISBROOKE

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