Australian Occupational Therapy Journal (2007) 54, 153156 doi: 10.1111/j.1440-1630.2006.00617.xBlackwell Publishing Asia Melbourne, Australia AOT Australian Occupational Therapy Journal 0045-0766 2006 Blackwell Publishing Asia Pty Ltd 51In PracticeDevelopment of driver assessment in victoria C. A. UNSWORTHDevelopment and current status of occupational therapy driver assessment and rehabilitation in Victoria, AustraliaCarolyn A. UnsworthLa Trobe University, School of Occupational Therapy, Bundoora, Victoria, Australia KEY WORDS driving, evaluation, history.IntroductionTheoccupationofdrivingishighlyvaluedbymanymembers of our community (Liddle, 2003). However,participating in driving may be challenged by congenitaldisabilities;accidentorinjuryresultinginphysical,cognitive/perceptualorsensorydisabilities;psychiatricdisorders or drug use; or factors associated with ageingsuch as deteriorating vision. Occupational therapistsaimtoensurethatindividualscanparticipateinasmany of their chosen occupations as possible, hence weare ideally placed to optimise an individuals capacitytodriveindependentlyandsafely.InthestateofVictoria,Australia,occupationaltherapistshavebeenformally involved in helping clients to drive or resumedriving over a 20-year period. This In Practice aimsto document the innovative thinking that led to thedevelopmentofthefieldofdriverassessmentandrehabilitation in occupational therapy in Victoria, thusacknowledgingtheworkofsomeofthepioneersinthisfield.Thearticlealsoexaminestheestablishmentof a training program for driver assessors, proceduresand standards for driver assessment and rehabilitationin Victoria, research in the field and future directions.The primary sources of information for this In Practicewereinterviewswithsomeofthesepioneers,andsurvivingdocumentsandreportsfromtheSchoolofOccupationalTherapy,LaTrobeUniversityandOTAUSTRALIA Victoria.Identifying the need for specialist driver assessment and rehabilitation servicesUntil 1986, only medical practitioners or optometristswere legally authorised in Victoria to make recommen-dations to the licensing authorities regarding a personsfitness to drive if the person was deemed to have adisability that could affect his/her driving ability. How-ever, occupational therapists including Sue Gregory andJennySymesworkinginaMelbournerehabilitationfacility (Bethesda Hospital) were concerned about thefitness to drive of their clients who had experienced braindamage, and the assessment procedures in place. Whenreflectingontheimpetusforoccupationaltherapiststo undertake driving assessments, Shelley Mc Laren(personal communication, October 2005) noted:Thecommonpracticeatthattimewastoinvolvea renowned driving instructor who was with theRACV and who had offered assessment and reha-bilitationtoclientswithadisabilitywithoneofthefirstmodifieddrivingschoolcars.Hewouldtakeclientsona1-hassessmentandreturntogivetheOTarecommendationabouttheclientssafetytodrive.Hisexperiencewasveryvaluableandhisopinionswererespected,however,theconcernwasthat while [he had] driving expertise and experience,there was limited knowledge of the functional implica-tionsofinjuriesanddiseases.ThelegalityofenforcingrecommendationswasdifficultandreliedonadoctorcompletingtheRTAformandthe insurance position of someone returning to drivewas unclear Occupationaltherapistsatthetimereasonedthatfitness to drive should be based on specialised off-road and on-road assessment procedures. In 1985, SueGregory was successful in obtaining funding includingan RACV Sir Edmund Herring Scholarship for a studytour of driver assessment practices in North America.ShewasaccompaniedbyEricMontgomeryfromTheDrivingEducationCentreofAustralia(DECA),whowasalsointerestedinthedevelopmentofsystemsCarolyn A. Unsworth PhD, BAppSci (Occ Ther), OTR, AccOT;Associate Professor.Correspondence: Carolyn A. Unsworth, La Trobe University,SchoolofOccupationalTherapy,Bundoora,Victoria3086,Australia. Email: c.unsworth@latrobe.edu.auAccepted for publication 5 July 2006. 2007 The AuthorJournalcompilation2007AustralianAssociationofOccupational Therapists154 C. A. UNSWORTH 2007 The AuthorJournal compilation 2007 Australian Association of Occupational Therapiststoensuredriversafetyfollowingaccidentorillness.SuesawtheopportunityforoccupationaltherapiststodevelopandleadthefieldinAustraliathroughdevelopmentofstandardproceduresforassessment,which she had noted were missing in North America.When reflecting back on this time, Sue mused [whatwe were doing] it was visionary, but at the time we werejust doing what we were doing (personal communica-tion, 29 August, 2005).Subsequently, a Driving for the Disabled Committeewas formed within the Victorian Association of Occupa-tional Therapists who worked together to develop acourse to train specialist occupational therapists indriver assessment and rehabilitation (described below)and lobbied relevant political groups to include occupa-tionaltherapistsasassessorsofdisableddrivers.TheCommittee was able to take advantage of the fact thatthe Road Safety Act was to be reviewed, and, in whatwe can now view as a profession-shaping achievement,the Committee was successful in having occupationaltherapistsincludedintheclassofpersonsabletoassessdisableddriversinSection27(Regulation229) of the 1988 regulations of the Road Safety Act 1986(Victoria).Sueremembersthedevelopmentofthedriverassessmentandrehabilitationfieldasbeinga very collaborative effort to grow it it was realteamwork. We had a vision and [we wanted to achievesomething in this field] for the profession (personalcommunication, 29 August, 2005).At this time, occupational therapists ensured thegrowth of the field by working on the AAOT workingparty on driving for the disabled, and kept assessorsup-to-date through circulation of a newsletter developedby Trudy Scott in 1988 titled Backseat Driver. In 1989, SueGregoryscontributiontothedevelopmentofdriverassessment was recognised through her nomination bythe Australian Association of Occupational TherapiststotheWorldHealthOrganizationasanexpertondriving for the disabled.Establishment of a driver assessment and rehabilitation training programAlthough occupational therapists were broadly classifiedin the Road Safety Act (1986) as able to assess disableddrivers, only occupational therapists who have under-taken post-graduate training in driver assessment areable to perform this task. Sue Gregory trained as adriving instructor in 1986 in order to assess clients.However,itseemedmoreefficienttodevelopacoursetotrainoccupationaltherapiststositinthebackseatofthevehicleandobservethedriverratherthantrainoccupational therapists as instructors. An instructorseated beside the driver would then be responsible forensuring vehicle safety. The first Occupational TherapyDriving Assessment Course in the world was offeredin February 1987 through Bethesda Hospital, DECAand the Victorian Association of Occupational Therapists(VAOT) (VAOTAnnualReport,1987). The course cost$A200 with a $A90 fee for resources, and ran for 2.5 daysin Melbourne and 7.5 days in Shepparton at DECA.Sue Gregory recalls the intensity of demand for trainingrequiringthecoursetorunfivetimesinthefirstyear(personalcommunication,29August,2005).AlthoughdriverrehabilitationprogramshadbeenrunningintheUSAsincetheearly1930s,thefirstCertifiedDriverRehabilitationSpecialistcertificationwasnotconferreduntil1988(Stav,2004).Inlate1987,thecoursewasrelocated to the School of Occupational Therapy, LincolnInstitute (which became La Trobe University the follow-ing year) and was run jointly with DECA. In 1990/1991,the ownership of all course materials was transferred toLa Trobe University, and the course was fully revised byRobinLovellandMarilynDiStefanointhemid-1990sandre-namedtheDriverEducationandRehabilita-tion Course. Over the ensuing 15 years, the course haseducated more than 100 occupational therapists from allover Australia (and internationally).Procedures and standards for driver assessment and rehabilitation in VictoriaThe first occupational therapy driver assessment clinicopened at Bethesda in 1985, and was rapidly followedbyRoyalTalbotRehabilitationHospital,CaulfieldGeneralMedicalCentreandHamptonHospitalasincreasingnumbersoftherapistsweretrained.How-ever,toincreaseuniformityinserviceprovisionitbecameapparentthatstandardsforpracticewererequired. In 1993, the Driver Management CommitteewasestablishedfromtheDrivingSpecialInterestGroup of the VAOT (now OT AUSTRALIA Victoria),withCherylSchneiderasthechair.Cherylhadrecog-nised the need for standards of practice and successfullyobtainedfundingfromtheOTTrustFundtodevelopthese. Leanne Healy was appointed as the project officer,and an expert working party was formed. Followingareviewprocess,thefirsteditionoftheCompetencystandardsforoccupationaltherapydriverassessorswaspublished in 1998 by OT AUSTRALIA Victoria. TheseStandards were validated through a process of reviewingthe performance of clinicians undertaking assessments(CherylSchneider,personalcommunication,30Sep-tember, 2005). However, as Cheryl notes, a mechanismto evaluate clinician performance against the standardswasrequired,andthisisyettobedeveloped.TheStandardswerefollowedin2000byResourcesandGuidelines for Occupational Therapy Driver AssessorsDEVELOPMENTOFDRIVERASSESSMENTINVICTORIA 155 2007 The AuthorJournal compilation 2007 Australian Association of Occupational Therapists(OTAUSTRALIAVictoria&VicRoads,2000).ThemajorcontributorstothisdocumentwereGeraldineJones through provision of a consultancy to VicRoads,andRussellScott(VicRoads).TheStandardsandResources,togetherwithmedicalguidelinesforAssessingFitnesstoDrive(firstpublishedin1998)(Austroads,2003),gaveoccupationaltherapistscleardirectionstoenableconsistentandobjectiveassess-ment of drivers.TheStandards(OTAUSTRALIAVictoria,1998)specify that an off-road assessment is conducted priortoanassessment(whereappropriate)oftheclienton the road. Dr Wendy Macdonald (School of HumanBiosciences,LaTrobeUniversity)hasmadealargecontributiontothedevelopmentofbothon-andoff-roadtestprocedures,andcompiledacomprehensivereportondriverassessorpracticescommissionedbyVicRoadstitledDisabledDriverTest(Macdonald,1993;1996), which was reviewed by the Driver Manage-ment group of the VAOT (VAOT Annual Report, 1995).In1986SueGregoryandShelleyMcLaren,amongothers, worked with John Fabre, Vin Lawrie and RTAstaff(nowVicRoads)todeveloptheearlyversionsoftheon-andoff-roadrecordingforms.Inaddition,therapistsneededastandardformforsubmittingclient assessment details and findings to VicRoads.Cheryl Schneider recalls identifying the need to makethereportingprocessmoreefficientwhileadheringtomedicolegalrequirementsandthereforeattemptedtostreamlinetherecordingprocessthroughdevelop-ment of an online reporting process (Cheryl Schneider,personal communication 30 September, 2005). Althoughthis was ultimately not possible, Cheryl and Russell Scottwere able to develop the current two-page version of theoccupationaltherapyreportingformwhichwasthenreviewed and endorsed by the Driving Special InterestGroup (available from www.vicroads.vic.gov.au).ResearchThefirstarticleondriverassessmentandtrainingtoappearintheAustralianOccupationalTherapyJournalwas concerned with Teaching the disabled adolescentto drive (Gregory, 1985). However, research by occupa-tional therapists in the field has been slow to progress,withrelativelyfewpaperspublishedintheJournalover the past 20 years. In an undated memo (ca 1988)from Sue Gregory (driver assessor course coordinator)to Glenys French (then Head of School of OccupationalTherapy, La Trobe University), Sue noted the researchprioritiesinthefieldwereto:researchthereliabilityand validity of an off-road cognitive assessment; researchthe reliability and validity of an on-road assessment; andconductalongitudinalstudytosurveytheoutcomeand effectiveness of driver retraining for persons withbrain damage. Nearly 20 years later, these research aimsremainlargelyunfulfilled.Thechallengeforthoseofusresearchingorworkingclinicallyinthisfieldistoworkcollaborativelytowardsfulfillingtheseresearchgoals.Nationally,atleastsixoccupationaltherapistsarecompletinghigherdegreesintheareaofdriving,andoccupationaltherapyresearchteamshavebeenestablished at several universities.Current status and future directionsCurrently, approximately 3300 driver assessments areundertaken annually by occupational therapy driverassessorsinVictoriawithsubsequentreportingtoVicRoads (Road Safety Committee, 2003). In the USA,theAOTArecentlyidentifieddriverrehabilitationasoneofthetop10emergingpracticeareas(AmericanAssociation of Occupational Therapists, 2002; Gourley,2002).Clearly,thereisenormouspotentialforgrowthin the area of occupational therapy driver assessment.This is in response not only to the ageing of the popula-tion, but an increasing awareness of the need to ensurethe safety of all road users through driver screening andassessmentprocedures(Gourley;RoadSafetyCom-mittee). The spotlight also recently turned to this fieldwhen the Road Safety Committee was called to reportto the Parliament of Victoria on issues affecting the safetyof older road users. Among the recommendations madeof particular relevance to occupational therapists includethe need to develop cognitive screening and assessmenttoolsfordriverlicensingpurposes,andthatresearchbe undertaken to better understand the effects on driv-ingperformanceofpersonswithvarioustypesandlevels of cognitive impairment, and to understand theeffects the various types and levels of medical conditionsandmedicationshaveonanolderpersonsdrivingability (Road Safety Committee).Summary and conclusionTwentyyearshavepassedsincetheoccupationalspecialtyareaofdriverassessmentwasdevelopedin Melbourne, Victoria. During this time, countlessoccupational therapists have volunteered their time andexpertise to develop what is now informally regardedasinternationalbestpracticeinthefield.InordertoadvancedriverassessmentandrehabilitationinVictoria, clinicians and researchers alike need to takestock by reflecting on the history and development ofthe field and set common goals for the future. This InPractice has documented the development of occupa-tionaltherapydriverassessmentandrehabilitationin Victoria, and acknowledges the work of some of thekey contributors in the area. In conclusion, occupationaltherapists in the field are urged to rise to the challenge156 C. A. UNSWORTH 2007 The AuthorJournal compilation 2007 Australian Association of Occupational TherapistslaiddownbytherecentParliamentaryenquiry(RoadSafetyCommittee,2003)andresearchcurrentassessmentprocedures,toensurethecontinuedviability of the field.AcknowledgmentsThis paper acknowledges the work of the occupationaltherapists who founded and developed this field inVictoria. In particular, thanks to Sue Gregory (occupa-tionaltherapist,privatepractice),CherylSchneider(manager, Occupational Therapy Services, MonashMedicalCentre)andShelleyMcLaren(occupationaltherapist, not currently practising) for the informationtheysharedduringinformalinterviews,andElaineHutton(OTAUSTRALIAVictoria)forprovidingAnnualReportswhichcontainedsummariesofkeyactivities of the Driving Special Interest Group/DrivingManagement Committee from 1984 to 2004.ReferencesAmericanAssociationofOccupationalTherapists(2002).Occupational therapy practice frameworks: Domains and process.Bethesda, MD: Author.Austroads (2003). Assessing fitness to drive. Sydney: Austroads.Gourley, M. (2002). Driver rehabilitation. A growing practicearea for OTs. OT Practice, March 25, 1520.Gregory,S.(1985).Teachingthedisabledadolescenttodrive. 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