• DRT Then to Now

DRT Then to Now

In 2016, the OT Practice cover story highlighted a Pilot “Bootcamp” program for High-functioning Autism to address Driving and Community Mobility (D&CM) needs of adolescents ages 15-19 with High-Functioning Autism (HFA) Disorder. This article was from July 25, and is posted on www.aota.org at www.aota.org/~/OTP-Volume-21-Issue-2013-driving-community-mobility.pdf. Several tidbits of helpful information and resources are mentioned in the article.

On multiple levels this “Bootcamp” is similar to what Missy Bell started for many more students and families several years before it. Missy is an Occupational Therapist with pediatric and Driver Rehab specialization. Her “Driving Readiness for Teens” (DRT) program was designed for various limiting but primarily “invisible disability” conditions and not just HFA. The DRT program from over 5 years ago has been re-vamped for Missy’s newest “total mobile” service approach. It now includes assistance for persons with more evident physical limitations and medical impairments known to reduce driving safety across the age span. The program will soon include specialty driving lessons as well that can assist with meeting state GDL mandates for teens and adults needing licensure or re-licensing.

The ECU research project mentions many tests, tools, and equipment utilized for their pilot study campers. Rather than having all the shiny bells and expensive whistles of a research-based University Health Sciences program, Missy utilizes more accessible field tools and resources along with OT skills in activity analysis, clinical reasoning, and creative yet functional and dynamic innovation. Missy’s goal has been to be an OT for the people.

Her program is based on an average therapist budget which is helpful for improving service access by the more everyday client base. Missy says that her program can result in essentially the same outcomes of this kind of study- only with better client-specific results due to less restrictions. She will credit that research studies are important and necessary for the field and is working on getting a grant to help support youth driving assessment norms development here in the states.

Missy always gathers important data metrics while working with clients. She knows they could be excellent subjects for case-study findings and this general practice helps measure outcomes of program participation. For that reason, her program participation waiver includes a blanket statement mentioning participation outcomes could be utilized for potential research and development.

Missy completes individualized and direct one-on-one intervention and occasionally small group or partner lessons, knowing that all student and family needs are often quite different. The balance of direct one-on-one services, caregiver-child collaboration, and small group is important for teenagers for a variety of reasons. The new program incorporates more of this type of diversity and activities that recognize if learned skills are able to be generalized to new situations.

Some families have had to drive many hours to work directly with Missy, and scheduled visits months in advance. Those sessions were much longer than average with a break in-between. Now, with her new mobile clinic, driving to other cities is a possibility. Families can pay a little more for travel expenses for her to visit them on occasion and are more than grateful for that option.

In the past, Missy had to help clients who had moved or taken extended vacation. Some were outside of the state; others outside of the US. For both these client factors, which limited direct OT services and accessibility to other providers, informal progress check-ups and discussions about “home program activities” were done via distance conferencing so that no major skill regression occurred until direct services could resume once again.

Today, computer advances accessibility allows similar convenience. Rather than drive to meet for pre-visit interviewing, the intake interview process can be done via Zoom, Facetime or Go-to-meeting type platforms and pre-participation screenings can be done privately beforehand using live documents (without personal or identifying information) rather than onsite. All evaluations and treatment are done directly but follow up check-ins can also be done via “telehealth” if most appropriate.

In Missy’s original program design, readiness services were designed for kids ages 13 to 18 but due to extensive young adults seeking services, the DRT was expanded to serve more young drivers and potential young driver needs rather quickly. It also included parent-teacher workshops and in-services as well as supplemental “Driving Reading Helper” packet. Some people were seeking help from outside of the state and all Missy could do was provide general information about “readiness skills” and refer them to the closest OT/DRS after getting a permit.

DRT program objectives were essentially the same as the aforementioned ECU “Bootcamp” pilot program. They were to improve performance skills, safe and independent “readiness” skills for potential driving and community mobility occupations. But also, to address important needs during transitions from adolescence to early adulthood while supporting and educating parents in need of help. Additionally, the DRT program helped appropriately refer to a hospital-based driving rehabilitation specialist for behind-the-wheel assessment or training, which now can be done by Missy herself.

Missy has always tried to prepare students for and referred appropriate clients to St. David’s Hospital of Austin Adaptive Driving Program. Their program OTs are DRSs and TA-Licensed Driving Instructors, like Missy Bell is today. St. David’s primarily work with adult driver needs a few hours a week in a clinic that serves other OT needs. They also serve more “evident” disabilities than invisible ones using a large adapted van. Having more experience with in-car equipment needs, Missy considers the driving rehab therapists at St. David’s field-mentors and hopes to work side by side with them someday soon.

Services for driver evaluation or training at this hospital are somewhat limited, however. They often have a long waitlist and no mobile services or training towards GDL requirements are offered. Missy has also built relationships with other driver rehab service providers for referral whenever necessary, such as for high-tech equipment prescription and training and she is working on partnering with a driver school for serving diverse student needs more appropriately.

She no longer runs her popular office-based driving readiness program with a fancy Driving Simulator, Interactive Metronome, Vision Therapy equipment and pricey assessments like the SIPT. Running a business, like Extra Credit! LLC taught a lot. The business space rent in the city of Austin makes it hard for any small business to thrive without compromising quality. Spending many thousands upon thousands to purchase and store big expensive and immobile equipment or barely used tests is unnecessary and wasteful. They almost all immediately become outdated and make overall treatment costs more expensive in order to pay back debts. This reduces service accessibility for people in need, which becomes further problematic. Furthermore, there are other pediatric OT settings who can bill insurance and provide Missy with testing information on commonly used tools such as the BOT-2 or Sensory Profile and Beery VMI. These are all good pre-driving clinical “readiness to drive” assessments.

Missy realized it would be more important to purchase a vehicle for real driver readiness and training rather than anything simulated at that price point. For the cost of an overrated machine that assessed clapping to a beat for 30 minutes, or a simulator that did little to nothing good for most kids other than learn how to play with fake primary “gaming” controls, adaptive equipment could be put in the car to allow more clients to be trained safely and to make sure functional on-the-road intervention was encouraged asap. Actual driving assessment tools could also be purchased that cannot be offered by any other provider and used for important field research pertaining to young drivers. So little of it is in existence.

Missy learned through experience, the best way to assess, treat, and research was with activities more directly related to actual driving and not simulated driving. This is what the parents appreciated most anyways. Even if just community-based activities, passenger-level training, or back-seat coaching lessons, these are what proved to be most helpful for all of the Driving Readiness for Teens program (DRT) participants

A mobile driving rehab program with assistance in driver education is simply the best way to go. Payment for services can stay roughly the same, but clients will be paying more for multiple conveniences of a mobile clinic. So many clients have been asking for this. Research and testing can still be done, but on a more case-by-case approach so that time is spent on exactly what is needed for the person rather than a group.

Duration and frequency of the new program remains individualized. It’s simply about putting the client factors and needs ahead of study ones. Thankfully, studies like the ECU pilot have already been done and don’t really need to be repeated but driving “Bootcamps” could be a fun and functional summer camp option for some kids and families. Missy is currently collaborating with Jennifer Allen (of Samuel Allen’s law) and Imagine-A-Way (non-profit) and local schools to help bring special events to the local communities as well as parent education on safe driving.

In the current form of DRT, photo and videos as well as computerized software is still utilized, but emphasis is on training with accessible materials. In other words, Missy teaches kids and families how to use tools that can be used outside of the clinic. In the real world, making trips to see an OT at rush hour right after school is not the best use of everyone’s “time”. And “Time” is an incredibly valuable resource noted during the Extra Credit! LLC run of the DRT program. In many cases, time was much more of a concern than any price of services. Parents are willing to pay for what is needed. The services like what Missy offers are frankly at little “cost” when compared to what costs an accident could result in.

Some of the more fun and helpful DRT program methods are still in use. Missy encourages meet-n-greet events with peace officers and simulated activities related to being pulled over, getting into an accident, having car trouble, or getting lost. She also has the kids and families make a safety car binder with all needed information organized in one place as well as a trunk-kit for emergency preparedness and send in video lesson completions of assigned activities such as observations of intersections, passenger-level commentary, and reporting of noticed/un-noticed social gestures and accommodating drivers.

Since receiving more specialized training and experiences, the Safe Driving & Rehabilitation DRT program includes more functional screening tools, a modified CarFit lesson, education about driver education lessons, and how to approach them and more “required” community mobility training fieldtrips for real life preparedness. Furthermore, in car training can be completed behind-the-wheel for students who have acquired a permit or license.

If family car accessibility or safety for parent-led training is a factor, then equipment prescription recommendations can be made, and some services can be done in the actual car the student will be driving. All parent-led and instructor training requires observation, lesson note taking, and consultation otherwise it is documented as unassisted and unadvised because it is assumed to be at the unnecessary risk of others. Sometimes, parent-led training is only advised after approved installation of prescribed safety equipment and all lesson work comes with an Individualized Driver Plan. The IDP includes occasional progress reports.

The new and improved DRT, which potentially will be re-named the “Safe Driving Readiness & Community Mobility Training” program, requirements are for safety. She has heard of several collisions of other student drivers while working with a regular instructor and parent. Some reported incidents include rather severe incidents. In all cases, fortunately everyone survived, but the events proved traumatic and stressful in other ways. For similar reasons and reporting of incidents, licensed students are not cleared to drive independently until a comprehensive behind-the-wheel evaluation and advanced safe driver training program by Safe Driving & Rehabilitation is completed. Missy puts everyone’s safety and well-being first and so she requires the strict following of guidelines and restrictions by any participants. Practicing best safety and ethics is really the only way to go.

To enroll in the current programs, contact Missy Bell.