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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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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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http://www.wiley.com
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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
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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.
vii
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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
xi
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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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