Canadian Association of Occupational Therapists

Report of the Professional Issue Forum on

Saint John, New Brunswick, May 2002

The Canadian Association of Occupational Therapists (CAOT) Professional Issue Forum on Universal Design and Growing through Occupation was developed in partnership with Canada Mortgage and Housing Corporation (CMHC)  CMHC and CAOT have collaborated on housing issues in the areas of seniors’ housing, housing for persons with disabilities, and universal design. This forum was an educational initiative to explore the relationship between health and housing, and to share information on universal design.

The Forum was held at the Saint John Trade and Convention Centre, May 27, 2002 from 1:30 to 3:30 pm.  Approximately 52 individuals participated in the forum, including CAOT conference delegates, invited representatives of CAOT constituent and stakeholder groups, three invited speakers and the forum facilitator.

The Forum consisted of panel presentations, roundtable discussion and large group discussion.  

Susan E. Doble, PhD, Associate Professor, School of Occupational Therapy, Dalhousie University

Brent Cliff, Brent Cliff Builders, President, Fredericton Home Builders Association
Tom Levesque, Manager, Assisted Housing, Atlantic Business Centre, CMHC
Laurie Ringaert, Universal Design Consultant, Director, Universal Design Institute, Faculty of Architecture, University of Manitoba, President, Universal Design International Consulting 

Objectives of the Forum were to:

  1. Profile occupational therapists’ contribution to universal design;
  2. Promote understanding of the role of various stakeholders in universal design including consumers, occupational therapists, builders, architects, and others involved in the housing industry;  
  3. Create networks among stakeholders to identify barriers to universal design implementation and opportunities for inter-sectoral collaboration; and
  4. Contribute to policy in the area of functional, safe environments for all Canadians through the development of a CAOT discussion paper on universal design.

Dr. Susan Doble introduced the session reviewing universal design as a concept that can support the occupational performance of many persons regardless of ability level and age.  Although these universal design principles can be applied to all built environments, tools, and materials, the forum was focused on the incorporation of universal design principles in the design of new homes (single family houses, apartments, condominiums, townhouses, seniors’ residences, etc). The purpose of using principles of universal design to guide our decisions about how built environments should be designed is to simply life for everyone, to ensure that a greater proportion of our population can use built environments, and to do all this at little or no extra costs.  Seven principles of universal design were reviewed and included equitable use, flexibility in use, simple and intuitive use,  effective communication, tolerance for error, low physical effort and appropriate size and space for use regardless of user’s body size, posture, or mobility (see: 

Participants were encouraged to consider the roles they might individually and collectively play in the adoption of universal design principles.  Many occupational therapists’ efforts are directed towards ensuring that individuals’ clients can perform occupations in accessible environments.  However, by shifting our focus on the principles of universal design, the effects of our efforts will be furthered such that all individuals, regardless of age or disability level, will benefit.

Panelist Presentations
Mr. Brent Cliff
shared his perspective on universal design as a homebuilder that works directly with individuals who want to build a new home.  Rather than simply taking pre-existing architectural plans brought to him by a prospective home owner who has already purchased land for building, Mr. Cliff emphasized that clients are able to make the most of his expertise when they involve him in the early stages of planning, ideally even before the actual land is purchased.  The lay of the land often dictates what housing designs will be feasible.  Whether clients choose to use the services of an architect or use more standard home designs available for purchase, involving an experienced builder with knowledge of universal design principles can be used to ensure that the home that is built will meet the individual’s or family’s needs at the present time and in the future.  Mr. Cliff emphasized that one of the features that prospective home owners need to be aware of is that significant financial savings can be realized when universal design features are incorporated into the new home designs.  Renovations of existing homes to meet the needs of persons with newly acquired disabilities tends to be very expensive, time consuming, and requires considerable creativity on the part of the designers and builders.  Although builders who do custom work are more likely to take the time to encourage clients to consider their own future needs and others (in terms of resale value of the home), not all builders are aware of universal design principles.  Moreover, builders involved in larger scale developments may be more focused on building homes to meet the immediate needs of those within the current market (i.e., families comprised of adults and children).  Both of these groups of individuals would benefit from the expertise of occupational therapists who might work with them to develop a highly marketable product, that is, homes that will meet prospective owners’ immediate and future needs. 

Mr. Tom Levesque shared with the group his expertise as the Manager of Assisted Housing, one of Canada Mortgage and Housing Corporation’s (CMHC) services.  CMHC‘s mandate is to help Canadians gain access to a wider choice of quality, affordable housing.  As Canada’s national housing agency CMHC provides Canadians with housing information and resources. CMHC has conducted research and produced practical information which reflect the principles of universal design, and that can be used to design and modify homes so that older adults and persons with disabilities can be active participants in their daily occupations within their homes. CMHC also has information about “flex housing,” which refers to housing that has been designed and constructed so that modifications that might be needed in the future can be made with little additional cost.  Several initiatives of CMHC were described including educational seminars, and financial assistance programs for housing (Residential Rehabilitation Assistance Program (RRAP), Home Adaptations for Seniors (HASI).

Mr. Levesque emphasized that as a national agency, CMHC is seeking to develop active partnerships with occupational therapists so that together we can try to ensure that the built environments in which Canadians live, work and play will enable support competent and safe occupational performance. 

Ms. Laurie Ringaert an occupational therapist with extensive experience as a universal design consultant, focused her presentation on the opportunities available to occupational therapists to facilitate change in the built environments in which our clients function.  She emphasized how the knowledge base and skill sets of occupational therapists provide a solid foundation from which we can extend our activities into consultation, education and advocacy with architects, builders, planners, and policy developers, clients, and other citizen groups.  To do this however, means that we must recognize that our focus must broaden beyond that of an individual client, to a community or systems level.  Change at these levels will not only result in positive changes for an individual client, but to the general population.

Ms. Ringaert also introduced the concept of “visitable” spaces.  A visitable space is one which individuals, regardless of their abilities, can access not just their own homes, but also the homes of family, friends, and neighbours, and other built spaces within their communities.  Recognizing that universal design reflects a number of principles that are unlikely to be fully realized within the near future, by focusing on the visitability of spaces, we work to ensure that individuals, regardless of their abilities, can, at the very least, get into someone else’s home or into a community space, spend some time visiting, access the bathroom, and leave without encountering barriers. 

Roundtable Discussion
Participants addressed the following questions in the roundtables:

1. What opportunities exist for occupational therapists to promote the concept of universal design in the home environment (new homes, apartments, condominiums, townhouses, seniors’ residences, etc).  Who else needs to be involved as partners if these new opportunities are to succeed?

2. What barriers might we encounter in promoting the concept of universal design? 
How might we break down these barriers and build a new model of practice?

Summary of Discussion
1.  Opportunities for occupational therapists
During the roundtable discussions, participants identified the opportunities that exist for occupational therapists, both from an individual perspective and from the perspective of the profession, to promote the concept of universal design in the home environment. 

  • Advocate for universal design in our own everyday lives; for example we can insist on such features when making personal purchases, renovating our own homes, making landscaping changes to our yards or serving on our local elementary school’s playground committee.
  • Many opportunities exist for occupational therapists working with clients on a one-to-one to promote universal design: in-home assessments, workplace assessments, and ergonomic assessments.  Occupational therapists can expand their role to promote universal design for not only an individual client but for all live, work and play in these same environments. 
  • Occupational therapists might consult with those designing and building new nursing homes, hospitals, hotels, museums, restaurants, and other public spaces.  We might provide educational services to architects, planners, developers, and builders to so that they will understand the principles of universal design but also recognize when the services of an occupational therapist consultant would be worthwhile. 
  • Occupational therapists might provide educational services to consumer groups to enable these individuals to assume advocacy roles to ensure that new public spaces are designed with the needs of seniors, disabled persons, and others with special needs in mind. 
  • CAOT may provide educational opportunities for members to learn more about universal design.  As well, CAOT could develop educational resources on universal design that members can use when interacting with various community groups, businesses, organizations, and other professional groups such as builders, planners and architects. 
  • CAOT might also initiate a health promotion project exploring how built environments promote or constrain the occupational performance of all Canadians, but with a particular focus on the occupational performance of those who are aging and those who are coping with disabilities. 

2.   Barriers to Promoting Universal Design

  • Need for public awareness of the principles of universal design, and how the implementation of these principles into everyday decisions would enhance everyone’s lives and well-being, not just those with disabilities. 
  • Occupational therapists lack the depth of knowledge of universal design principles needed to contribute to the change process.  More importantly, we have traditionally focused our efforts on improving accessibility for individuals with disabilities; to successfully implement the principles of universal design, occupational therapists need to effect change on a larger scale. 
  • To effect changes at a broader community-level, a group of occupational therapists who are experienced and knowledgeable about universal design, who understand how to effect change at an organizational/institutional level, and who can confidently “sell” their expertise is needed. 
  • The expertise that occupational therapists can bring to universal design must not only be valued by decision-makers but recognized monetarily. 

3.   Strategies to Break Down these Barriers
Five major strategies were identified:

  1. The provision of opportunities for occupational therapists to learn more about the principles of universal design both at an entry-level education level, graduate level, and continuing education level.  Occupational therapists also need opportunities to learn how to market their expertise and skills, and how to lobby to effect change. 
  2. Development of a CAOT position statement on the role of occupational therapists in universal design.
  3. Development of educational resources such as toolkits that can be used by occupational therapists to educate others about universal design. 
  4. Provision of opportunities for individual occupational therapists, professional organizations, and CAOT to develop effective partnerships with contractors, builders, architects, developers, city and municipal planners, local governments, provincial and national associations that deal with the concerns of seniors, disabled persons, and others at risk such as limited finances.  Partnerships also need to be forged with associations that set building standards for different types of housing situations, and for other public buildings.
  5. The recognition by occupational therapists that change needs to start in our own backyard.  As occupational therapists, we need to rise to the challenge to begin to ensure that principles of universal design are evident in the built environments where we work, play and live.  Success stories could become the motivation for others to begin to effect changes.

Submitted by: Dr. Susan Doble, Facilitator

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