Wendy B. Stav; Developing and Implementing Driving Rehabilitation Programs: A Phenomenological Approach. Am J Occup Ther 2012;66(1):e11-e19. doi: 10.5014/ajot.2012.000950.
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© 2019 American Occupational Therapy Association
This qualitative research study examined the experiences of practitioners who developed and implemented driving rehabilitation programs within the past 5 yr. Researchers interviewed 4 occupational therapists with 10–19 yr of experience, who identified the following facilitators of and barriers to driving program implementation: funding and equipment, institutional support, interdisciplinary conflict, role expectations, professional development, and staffing. Results support prior quantitative research identifying barriers to developing and sustaining driving and community mobility programs. Findings also suggest that program success is dependent on much more than clinical expertise. Results provide occupational therapists with a foundation of expectations when developing new programs to assist them with anticipating and counteracting barriers to success.
What are the experiences of occupational therapists who have developed driving rehabilitation programs?
What successes and barriers have occupational therapists experienced in the development of driving rehabilitation programs?
Frustration . . . trying to get people on board and to understand what we were doing. . . . I don’t think the physicians really knew what kind of service we [were] able to give them. . . . They really need to get the support of their management, and to make it very clear this is a risky endeavor and things can happen, so everyone is understanding when they start.
It has been just kind of a satisfying thing; the department manager right now is very supportive of changing and improving things and letting me go to workshops and whatever I need to do. I think it has been, all in all, very positive. . . . We’ve got doctors that are just thrilled . . . because it takes the burden off of them having to say “You can no longer drive” because somebody else has to do it, and that part is fine.
Physical therapists . . . have [little] idea of what we do. . . . I have worked places where somebody else did the clinical [evaluation]. . . . I had a neuropsychologist do the clinical part and then I was supposed to just drive them. . . . That did not work well because the neuropsychologist did not look at the person like an OT would.
You would go behind the wheel with an educator and not someone with[an] OT’s knowledge base, and they would be determining safety behind the wheel. . . . I would give them a little bit of medical background. . . . It would be . . . a 15–25-minute drive and that was it, and you can hit every light right, you can hit every turn right in that short period of time, and it looks good, but . . . they [driver educators] would be the one determining [whether clients] would be safe behind the wheel.
I was invited to . . . talk to a group of [medical] residents in town. . . . When you first go in there, they . . . think you’re this crazy person that takes . . . people on the road. [I] explained our program and have developed . . . really great relationships with those physicians after they leave their residencies, and they keep referring to us.
go somewhere and actually be kind of immersed in the program for a period of time to really see it and then to stick with the diagnoses they [clinicians] know quite well. . . . And then if they continue to go to courses to expand their area, they take it nice and slow [and] know what they are doing. . . . Because they can’t afford to make a mistake.
I don’t think this is really a job for somebody who is just out of school because you have to know the intricacies of so many diagnoses and disabilities in order to be able to make a proper assessment, and I think it really takes someone with experience, so you have to find someone who is really willing to do it, has passion for it, . . . understands the responsibility they have with it.
One therapist we have trained has a specialty interest in other areas of OT. . . . We trained her, but we can hardly ever use her because she is being utilized in so many other ways that her availability to us is too limited, because they need her for—I guess I would call it—the medical aspect of OT. You know, we can put somebody on hold to bring them in for driver rehab, but you can’t [hold off rehab] after they had a stroke and they need regular rehabilitation.
Development of educational opportunities at both the entry level and continuing education level focused on recognition of and fulfillment of additional roles and skills,
Increased advocacy efforts with administrators to improve support for programs and the practice of driving rehabilitation, and
Establishment of a mentoring program to facilitate the professional development of practitioners new to the practice area.
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