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CAOT Position Statement
Universal design and occupational therapy (2009)

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Universal design creates environments, materials and tools that provide accessibility, adaptability, ease of use, and safety. Occupational therapists have the knowledge and skills to be experts in universal design. Universal design contributes to health and well-being by enabling engagement in self-care, productivity and leisure. Occupational therapy in Canada is based on a model of practice that recognizes the interaction between occupation and the social, cultural, physical and institutional environment.

CAOT Initiatives
To promote occupational therapy in universal design, CAOT will:

1. Work in collaboration with stakeholders such as national and regional jurisdictions, professional associations, health and human service organizations and communities to promote implementation and evaluation of universal design principles for built environments, materials and tools.
2. Promote the understanding of the relationship between engagement in healthy and accessible environments, occupational engagement and health and well-being.
3. Provide continuing professional education and practice resources to support occupational therapists understanding and use of universal design principles.
4. Provide evidence-based universal design resources to consumers for the promotion of occupational engagement.
5. Support collaborative research to promote universal design for occupational engagement.

Recommendations for occupational therapists:

1. Interdisciplinary research be undertaken to understand the relationship between health and the environment including investigating how environmental factors contribute to occupational engagement.
2. Occupational therapists develop partnerships with consumers and stakeholders to promote universal design principles for built environments, materials and tools in order to support occupational engagement.
3. Occupational therapists advocate for universal design principles to decision makers through representation on appropriate committees in governments, associations and organizations.
4. Occupational therapists educate others in their community about the principles and benefits of universal design on occupational engagement.

Background

1. The built environment, including “homes, schools, workplaces, parks, business areas and roads”, is an important determinant of health and can influence our physical and psychological well-being (Health Canada, 1999, p. 104). Housing and health are closely related; they have a major impact on quality of life, particularly for older adults and persons with disabilities (Levesque, 2002).
2. Occupational therapists believe that the performance, organization, choice and satisfaction in occupations are determined by the relationship between persons and their environment (Canadian Association of Occupational Therapists, 2002). The Canadian Model of Occupational Performance and Engagement (Townsend & Polatajko, 2007) defines the environment as having cultural, institutional, physical and social elements that can enable or constrain occupational performance. Occupational therapists have the knowledge and skills to identify factors that allow people to engage in daily activities and the means to assist people in removing barriers to participation (Baum & Law, 1998). Occupational therapists may utilize key enablement skills such as adapt, advocate, coach, collaborate, consult, coordinate, design/build, educate, engage and specialize(Townsend & Polatajko, 2007) to ensure principles of universal design are implemented to enable occupational engagement of our clients.
   
   Occupational therapists work with clients who are individuals, families, groups, communities, organizations or populations (Townsend & Polatajko, 2007). The Profile of Occupational Therapy Practice in Canada (Canadian Association of Occupational Therapists, 2007) outlines that occupational therapists use knowledge of occupation, occupational engagement, and other appropriate processes and interventions of enablement in the evidence-based provision of client centred services that are current, ethical and are uniquely designed, and flexible to respond to changing conditions in the occupations, persons, and environments of the client, service providers, and service systems.
3. Most typically, occupational therapists perform home, school and work site visits, recommend modifications, assistive technology, and ergonomic tools and materials, to enable clients to engage in meaningful and cultural relevant occupations in their chosen environments.
4. Universal design is a concept that can support the occupational performance of many persons regardless of ability level and age. Universal design principles guide decisions about built environments, materials and tools. The goal is to simplify life for everyone, ensuring usability by a greater proportion of Canada’s population. Human performance, social, cultural, engineering and economic factors are also considered in universal design. Developing and promoting environments that enable the performance of persons of all ages and abilities incorporates universal design principles and broadens the potential for occupational therapy services.
5. The majority of persons in Canada live in residential properties that have not been designed according to universal design principles. If each new dwelling was designed and built according to universal design principles, the need for future expensive renovations and changes could be substantially reduced or eliminated (Doble, 2002). There remains significant potential for individuals to be able to remain living in their current homes and existing communities (Doble, 2002).
6. FlexHousing is an opportunity to accommodate the needs of people with diverse abilities (Canada Mortgage and Housing Corporation, 2000). It incorporates universal design principles by building features into a home during initial construction to accommodate the changing needs of persons allowing them to remain independent in their own home. FlexHousing includes adaptable design such as reinforcing walls in bathrooms to make it easy to install grab-bars; accessibility such as wider-than-standard doorways; affordability, and Healthy Housing including air quality and energy efficiency.
7. Visitability refers to newly constructed, single-family homes with the following minimum features: a level entrance at the front, back or side entrance, door openings with a minimum of 32 inches (813 mm), and a half bath on the main floor. The three minimum guidelines to achieve visitability ensure that everyone, regardless of mobility, will be able to at least visit someone else’s home, use the washroom and exit the home. (Visitabily Canada, n.d.).
8. Occupational therapists are encouraged to consider the roles they might individually and collectively play in the adoption of universal design principles which include equity in use for people with different abilities, flexibility in use, simple and intuitive use, communication of necessary information effectively to the user, reduction of hazards or adverse consequences, low physical effort, and appropriate size and space for function regardless of the person’s body size, posture, or mobility (Center for Universal Design, 1997).
9. Occupational therapists have realized opportunities to use their expertise in community development and have expanded their services to include the promotion of universal design to improve the health of the public. This shift in service delivery has required the development of new competencies such as knowledge of building codes, standards and guidelines; architectural drawings, best practices in universal design and environments beyond housing such as parks and commercial venues (Ringaert, 2002).

Glossary of Terms
Canada Mortgage and Housing Corporation (CMHC): As Canada’s national housing agency, CMHC provides residents of Canada with housing information and resources including research, educational seminars and financial assistance programs for housing. Web site: http://www.cmhc.ca/

Canadian Model of Occupational Performance and Engagement (CMOP-E): is an extension of the 1997/2002 conceptual framework that describes occupational therapy’s view of the dynamic, interwoven relationship between persons, environment, and occupation (Townsend & Polatajko, 2007, p. 364-365)

Enabling occupation refers to enabling people to “choose, organize, and perform those occupations they find useful and meaningful in their environment” (CAOT, 1997: 2002, p. 180). Taken from Townsend & Polatajko, 2007, p. 367.

Occupations are groups of activities and tasks of everyday life, named, organized, and given value and meaning by individuals and a culture; occupation is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity); the domain of concern and the therapeutic medium of occupational therapy (CAOT, 1997, 2002); a set of activities that is performed with some consistency and regularity; that brings structure and is given value and meaning by individuals and a culture (adapted from Polatajko et al., 2004; and Zimmerman, Purdie, Davis, & Polatajko, 2006).

Occupational engagement: to involve oneself or become occupied, to participate in occupation (Houghton Mifflin Company, 2004). Involvement for being, becoming, and belonging, as well as for performing or doing occupations (Wilcock, 2006). Taken from Townsend & Polatajko, 2007, p. 370.

Universal design: “the design of products and environments to be usable by all people, to the greatest extent possible, without the need for adaptation or specialized design” (Mace, 1997, para.1).

References
Baum, C., & Law, M. (1998). Community health: A responsibility, an opportunity, and a fit for occupational therapy. American Journal of Occupational Therapy, 52, 7-10.

Canadian Association of Occupational Therapists (1997; 2002). Enabling occupation: An occupational therapy perspective. Ottawa, ON: CAOT Publications ACE.

Canadian Association of Occupational Therapists (2007). Profile of Occupational Therapy Practice in Canada. Ottawa, ON: CAOT Publications ACE.

Canada Mortgage and Housing Corporation (CMHC) (2000). FlexHousing: The professional’s guide. Ottawa, ON: CMHC.

Center for Universal Design (1997). The principles. Retrieved May 27, 2002 from http://www.design.ncsu.edu/cud/univ_design/princ _overview.htm

Doble, S. E. (2002). Universal design for growing through occupation. In Universal design for growing through occupation. Professional issue forum conducted at the conference of the Canadian Association of Occupational Therapists, Saint John, New Brunswick.

Health Canada. (1999). Second report on the health of Canadians. Ottawa, ON: Health Canada Publications.

Houghton Mifflin Company (2004). The American heritage® dictionary of the English language (4th ed.). Retrieved September 2, 2006, from http://www.answers.com

Levesque, T. (2002). Canada Mortgage and Housing Corporation. In Universal design for growing through occupation. Professional issue forum conducted at the conference of the Canadian Association of Occupational Therapists, Saint John, New Brunswick.

Mace, R. (1997). What is universal design? Retrieved May 27, 2002 from http://www.design.ncsu.edu/cud/univ_design/ud.htm.

Polatajko, H. J., Davis, J. A., Hobson, S., Landry, J. E., Mandich, A. D., Street, S. L. et al. (2004). Meeting the responsibility that comes with the privilege: Introducing a taxonomic code for understanding occupation. Canadian Journal of Occupational Therapy, 71(5), 261-264.

Ringaert, L. (2002). Universal design and occupational therapy. In Universal design for growing through occupation. Professional issue forum conducted at the conference of the Canadian Association of Occupational Therapists, Saint John, New Brunswick.

Townsend, E.A. & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being & Justice through Occupation. Ottawa, ON: CAOT Publications ACE.

Visitability Canada (n.d.). Visitability definition. Retrieved August 7, 2008 from http://www.visitablehousingcanada.com/index.html.

Wilcock, A. A. (2006). An occupational perspective on health (2nd ed.). Thorofare, NJ: SLACK, Inc.

Zimmerman, D., Purdie, L., Davis, J., & Polatajko, H. (June, 2006). Examining the face validity of the taxonomic code of occupational performance. Presented at the Thelma Cardwell research day, Faculty of Medicine, University of Toronto, ON, Canada. Retrieved March 28, 2007, from http://www.ot.utoronto.ca/research/research_day/documents/rd_06_proceedings.pdf.

The following are related CAOT Position Statements:
Assistive Technology and Occupational Therapy 
Occupations and health 
Health Promotion and Disease Prevention 
Home Care

Position statements are on political, ethical and social issues that impact on client welfare, the profession of occupational therapy or CAOT. If they are to be distributed past two years of the publication date, please contact the Director of Professional Practice, CAOT National Office, CTTC Building, 3400-1125 Colonel By Drive, Ottawa, ON. K1S 5R1. Tel. (613) 523-2268 or e-mail: practice@caot.ca.

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