Training Services Presentation for Trillium Health Partners The - PowerPoint PPT Presentation

Driver Assessment & Training Services Presentation for Trillium Health Partners – The Mississauga Hospital Shah Baqar, OT Reg. (Ont), CDRS October 6, 2017

Objectives • OT’s role in identifying risk factors / screening for driving • Recent changes to the laws - Occupational Therapists as reporters (to the MTO)? • CMA Driver’s Guide • Medical Review Process • Role of the Functional Driving Assessment • Adaptive controls, accessible vehicles and other equipment

OTs Role in Screening • OTs working at hospitals and in the community play a pivotal role in identifying medically at risk drivers. • Important for OTs to in such setting to improve their competence and confidence in screening medically at-risk drivers. • Developing a facility policy / algorithm on how to address driving can be very helpful

OTs Role in Screening • OTs use standardized and non-standardized assessment tools • There is no single quick screen to determine who should be assessed for driving – holistic approach • Address driving as a part of your assessment • Review premorbid driving patterns and the possibility that the client may return to driving • Review impairments and the possible impact on driving ability

Screening - Physically are there any major barriers that would affect client’s ability to operate the vehicle? - Are there cognitive impairments present that may make it potentially dangerous for the client to drive? - Are there red-flags: Difficulties with IADLs, self- reported/family reports of actual driving issues (co-piloting, confusing gas and brake, getting lost)? - Other acute issues: effects of medications, deconditioning/fatigue, emotional state, visual issues

Physicians Duty to Report Section 203 of the Highway Traffic Act: • Every legally qualified medical practitioner shall report to the Registrar the name, address and clinical condition of every person sixteen years of age or over attending upon a medical practitioner for medical services, who, in the opinion of such medical practitioner is suffering from a condition that may make it dangerous for such person to operate a motor vehicle. • No action shall be brought against a qualified medical practitioner for complying with this section. • The report referred to in subsection (1) is privileged for the information of the Registrar only and shall not be open for public inspection, and such report is inadmissible in evidence for any purpose in any trial except to prove compliance with subsection (1). R.S.O. 1980, c. 198, s.. 203. • Note: Similar provisions are in place for optometrist to report visual conditions under section 204.

Recent Changes to Highway Traffic ACT • The provincial government recently passed legislation to update Section 203 of the highway traffic act. • The updated law allows the MTO to write policies that identify the professionals named in mandatory and discretionary reporting. • The MTO is in the final stages of stakeholder consultation regarding which professions will be mandatory and which will be discretionary. • The policy was originally supposed to take effect July 2017, but his has been delayed to 2018 • OTs will likely be on the discretionary reporting list.

OTs as ‘Discretionary Reporters’ • What would this mean? • OTs will be able to report to the MTO (i.e. MTO will accept reports from OTs) • OTs would be protected if they report to the MTO • OTs must consider their role / responsibility in screening for driving within practice context • OT must increase their own level of competence in addressing fitness to drive • COTO’s expectations of OTs in protecting the public with respect to medically - impaired drivers.

CMA Driver’s Guide

Reporting: CMA Driver’s Guide “All provinces and territories impose a statutory duty on physicians relating to the reporting of patients deemed unfit to drive. This duty may be mandatory or discretionary, depending on the jurisdiction. The duty to report prevails over a physician’s duty of confidentiality.” (page 11)

Reporting: Food for thought  Protection for filing medical report  Action against physicians for not reporting  CMA recommends  physician informs the patient that a report has been filed  document any discussion of this topic  how to handle short-term impairment  err on the side of reporting

What happens once a report is filed?  A file is opened with the Medical Review Section  Report is screened and prioritized  The case is reviewed by an analyst  If medical standards for driving are not met, driver’s license is suspended.  Consideration for reinstatement occurs when appropriate medical information is received and reviewed.  In situations where the medical condition may effect driving, the MTO will typically require a driving assessment (must be completed by a certain date)

Functional Assessment  CMA asserts that there is an emerging emphasis on the functional assessment.  “Medical standards for driver’s often cannot be applied without considering the functional impact of the medical condition on the individual.” (page 8)  All Canadian jurisdictions have policies in place that allow individuals the opportunity to demonstrate that they are capable of driving safely despite the limitations implied by a diagnosis.

Functional Assessment  In Ontario, functional driving assessments are performed by MTO Approved Driver Rehabilitations Centres  Is a comprehensive assessment  Is administered by occupational therapists and driving instructors  Includes in-clinic assessment & on-road assessment  Cost: $570 to $750

The Nature of the Assessment: The In-Clinic Evaluation  Introduction, establishing consent (10 minutes)  Interview Intake (30minutes)  Vision Screening (5 minutes)  Clinical Assessment: (45 minutes)  The nature of the client’s condition will dictate the specific assessment tools that are utilized by the assessor during clinical testing.  Example of tools to assess physical skills: range of motion, strength testing, coordination tests, proprioception tests, transfers, standing/walking; anthropometric measurements & measurements of wheelchair.  Examples of tools to assess cognitive visual perceptual skills: MVPT-R & 3, CTMT or Trails A & B, UFOV, COGNISTAT, Judgment Questionnaires, DriveABLE Cognitive Assessment Tool (DCAT)

The Nature of the Assessment: The On-Road Evaluation  Conducted in the facility vehicle with a certified driving instructor. This portion of the assessment lasts approximately 45 minutes.  The facility vehicles have dual-controlled brakes.  The nature of the on- road assessment will depend on the client’s condition and goals. The purpose of the on-road assessment may include:  To assess for ‘fitness -to- drive’  Introduce / assess the client’s ability to drive with adaptive controls  To establish base-line / learning potential (potential to benefit from training)  To explore other technology and vehicle modification options  Client’s driving history and comfort are key factors that will influence progression.  Standard course includes industrial, residential, main roads and highway as well.

Recommendations  Adaptive controls required for driving-  Training is always recommended  A formal on-road reassessment would be required at the end of training to verify progress and establish ‘medical fitness to drive’.  Recommendations about technology to improve ability to ingress/egress, load/unload mobility device, or wheelchair accessible vehicle may be made.  Fitness-to-drive-  Continue driving functional driving skills  Driving cessation if driving skills are deemed outside the range of normal, healthy driving  Training may If client demonstrates good rehabilitation potential. A reassessment would be required at the end of training to establish fitness-to-drive.

Vision Waiver Assessment • Client’s that don’t meet MTO Visual Field Standards that wish to resume driving have to go through the Vision Waiver Program. • MTO inclusion/exclusion criteria (good driving records) • Satisfactory medical and vision waiver report from optometrist or ophthalmologist • Functional Vision Waiver Assessment is completed at Driver Rehabilitations Facilities authorized by the MTO to do them. • Is a 3-4 hour long assessment (includes both in-clinic and on- road).

Technology for Driving: Low Tech  Mechanical adaptive controls are ‘low - tech’ devices that can be used to compensate for physical impairments.  Examples include spinner knob, hand controls, and left foot accelerator.

Technology for Driving: High Tech  Technology to improve vehicle access includes: motorized turning seats or transfer boards, wheelchair lifts and hoists, robotic devices that help stow and retrieve wheelchairs.

Technology for Driving: High Tech  A variety of high- tech devices exists for client’s with more involved physical limitations for independent driving, for example reduced effort steering, relocated secondary controls, electronic shifter.  Clients with severe physical limitations may be able to drive with electric controls.