Driving rehabilitation program development

Planning and development

Explore this section to learn more about medical conditions, their potential impact on driving risk and driver safety, and the range of driving rehabilitation program models committed to addressing this critical instrumental activity of daily living. By developing referral pathways and dedicated programs that recognize and address driving, driving potential and driver risk, occupational therapy will be increasingly recognized as the go-to profession for addressing this highly valued client centered goal.

The National Highway Traffic Safety Administration (NHTSA) has developed a series of factsheets and videos on medical conditions and their potential impact on driver safety. All factsheets, posted resources and video clips are available for download and distribution to the public.

View NHSTA resources

Setting up referral pathways

The key to the success of an occupational therapy driving program is building a reliable, sustainable, and broad-based network of partners and referral sources.

Successful driving programs build relationships with a network of providers, from community based education to driving schools to medically focused driving rehabilitation programs. Begin by exploring and understanding the scope of services available in your local area, and then expand to understanding the broader specialty programs, such as high-tech van programs, that may require distance referral and travel. Refer to the Spectrum of Driving Rehabilitation Services chart, and identify local providers in each area. If no programs exist, consider developing a program to fill this gap in service delivery in your community!

Even staff at established programs must do thoughtful, cost-effective, continuous marketing to various audiences in the community. Successful strategies rely on explaining what you do, why you do it, and how older driver safety and community mobility affect communities.

Gather information

• Create written descriptions or fact sheets summarizing services and other community-based resources.
• Describe the range of services offered.
  • Describe clinical driving assessments and or the process and criteria to refer clients to other providers
  • Describe the range of clinical and behind-the-wheel assessments, on-road assessments, equipment evaluation and training, lessons and training, or clinical remediation services
• Develop an inventory of educational programs in your community, such as AARP's Safe Driving Program or other driving education programs that support drivers in their goal to continue behind the wheel. Describe services they offer and the training and outcome expectations by program.
• Describe the driver licensing requirements that specify medically related criteria that specify driver licensing minimums that may include visual acuity, peripheral field minimum requirements, seizure free status, etc. These criteria vary by state. In addition, know the driver licensing reporting laws in your area, the availability of reporting forms and the roles of physicians and occupational therapy practitioners in reporting or providing data used by the state driver licensing agencies when making determinations for licensing or restricting driving.
  • Refer to or download the Clinician's Guide to Assessing and Counseling Older Drivers, 4th edition.
  • Understand the role and policies of your state's driver licensing Medical Review Board.
  • Understand the rules for each state, with added caution and clarity when your client referral base is from multiple states.
• Download the PDF file, Ethical Issues Related to Payment for Service Delivery.

Educate the therapy staff in your facility

• Conduct focused discussion groups on topic related to the importance of driving, access to safe mobility options and the importance of transportation to engagement and participation in community.
• Invite staff and specialists from area driving rehabilitation programs and Mobility Dealerships to visit your program, and build awareness of the range of programs, services and providers.
• Explore all of the ways you can improve your program's inclusion of driving and community mobility as an IADL by:
  • Build a Driving Risk Assessment program
  • Participate in CarFit and community outreach
  • Disseminate educational information and resources to clients and staff
  • Develop your referral process, between internal program departments and area providers to ensure access and service delivery for the right person at the right time.
• Define programs and community resource networks.

Conduct community-based education with clients and potential professional referral sources:

• Meet with physicians and managed care groups to discuss the impact of driving and community mobility on quality of life and activities of daily living.
• Meet with consumer support groups that represent the concerns and needs of individuals with particular diseases or conditions (e.g., stroke, arthritis, Alzheimer's disease, Parkinson's disease).
• Access speaker toolkits, to develop the most clear concise and up to date messages.

Establish relationships with print and broadcast media:

• Serve as a credible, trustworthy source of information to comment on breaking news stories about older drivers and other community mobility issues.
• Contact local cable TV and radio channels that have community public events shows.
• Educate show producers about the impact of older driver safety and community mobility issues on the quality of life in your community.
• Participate in media awareness campaigns such as Older Driver Safety Awareness Week held annually during the first full week of December.
• Explore the media toolkit in our Driving and Community Mobility Toolkit for information and recommendations.

Understand the array of provider education, equipment and resources typical of a driving program. Consider how the scope of clinical evaluation, equipment evaluation and the training in its use or application distinguishes the driving rehabilitation program from a driving school, a state run driving or licensing Test or a community based driving education program. By understanding the scope and equipment involved you will be better equipped to distinguish providers and services beyond comparison focused only on fees or cost to clients.

Equipment may include:

• For vehicles
  • Cellular phone, cameras or recording technology
  • Evaluator's Eye-check mirror and instructor training brake
  • Insurance for all vehicles (note: it is important to distinguish vehicle (crash) risk from practitioner professional liability risk)
• Specialized equipment specific to client need
  • Adaptive mirrors
  • Samples of adaptive driving equipment (extent varies by program)
    • Alternate steering devices, mechanical or electronic
    • Crossover turn signal
    • Left-foot accelerator
    • Hand controls
    • Pedal extensions
  • Sample positioning equipment
    • Seat cushions
    • chest straps
  • Vehicle modifications including entry/exit/transport
    • valet or swing out seats, modified seating driver or passenger
    • Wheelchair lift or ramp
    • Wheelchair tie-downs
• Assessment equipment, "clinical"
  • Clinical Assessment tools and evaluation batteries
    • Brake-reaction timer
    • Cognitive assessments
    • Visual perceptual tests
  • Driving simulator
    • Risk assessment
    • Training

Too often the perception of limited access to funding or high costs associated with driving evaluation and intervention interferes with building awareness of what might be possible through driving rehabilitation services.

The discussion of driving possibilities should not be restricted or withheld due to the perception of costs. There are numerous options available to help individuals with funding both evaluation programs and their adaptive equipment needs for their vehicles.

Consulting a driving rehabilitation specialist even very early on in the recovery process can optimize a patient or family's ability to anticipate and plan for future transportation goals. For a general overview of the scope of adaptive devices, download the PDF brochure, Adapting Motor Vehicles for People with Disabilities, from NHSTA. An extensive review of funding options is updated on the National Mobility Equipment Dealer Associations website at www.nmeda.org. Explore the options below for additional information:

• Car manufacturer discounts (search for Mobility programs)
• Federal and local government programs
• Local organizations and charities, disease specific associations
• Medicare, Worker's Comp, Vocational Rehabilitation and Veteran Administration
• Explore partner websites and search for driving or older driver

When exploring the possibility and scope of a new driving rehabilitation program, you may begin by conducting a thorough needs assessment, understand the scope of services available and the client populations who may be underserved.

• Identify specific target populations in need of services.
• Distinguish the cost for staff training and specialized equipment when exploring program models that range from a basic driving risk assessment focus to a high tech van driving rehabilitation program.

A needs assessment may include:

• Collecting, analyzing and synthesizing relevant data
• Conducting a Strength Weaknesses Opportunities Threats (SWOT) analysis
• Explore the potential to partner, initially or long term. Interview driving instructors for their potential to offer the on-road component in collaboration, a referral program with local comprehensive driving rehabilitation programs, relationship with low vision programs or providers of transportation support

Information to be considered in the collection of data includes:

• Facts about the potential clients and existing services in the area
• Demographics of the population being targeted (including statistics)
• Percentage of individuals over the age of 65 in the area
• Percentage of “baby boomers” in this community
• Youth driving programs and driving education programs who work with novice drivers

One of the most critical factors in developing good driving rehabilitation programs is the personnel. Understand the training options and the qualifications required to offer both clinical and on-road services in your state. Consider:

• Credentials and certifications. Driving rehabilitation specialist with certification from AOTA (specialty certification up to 2020) or The Association for Driver Rehabilitation Specialist (ADED) certified driver rehabilitation specialist (CDRS)
• State requirements for driving instructor licenses, driving school requirements, etc. Requirements vary by state.

Driving programs commonly vary in scope and services. Most do not have the budget or professional staff training to offer a full spectrum of services. Nor do they need to! It is imperative to understand that program models vary, and can be tailored to address the needs of specific client populations.

The clientele needs may range from the young novice driver learning to drive a modified vehicle to an older driver managing to accommodate losses in driving capacity. The programs that serve them may vary widely. A highly qualified driving rehabilitation program may elect to focus on a specific population such as dementia and driving, older drivers or autism and driving. It is crucial to understand the scope and ensure that your client is referred to the most appropriate program to address their needs.

• Assessment
  • Clinical (possibly provided also from an OT clinical program)
  • Adaptive equipment assessment
  • Behind-the-wheel or On-Road assessment
  • Community mobility or transit assessment (passenger, rider)
  • Van program
• Intervention
  • Adaptive equipment prescription and training
  • Behind-the-wheel training or lessons
  • Interventions focused on remediation of visual, physical, and cognitive skills
  • Travel training
  • Van program, manage equipment, entry/exit
  • Manage, load and transport mobility devices
• Counseling
  • Transportation Planning
  • Cessation counseling, cessation compliance
  • Education within the community
  • Mobility management