Chapter 4:
Survey of State Licensing Officials

Purpose

A number of issues bearing on Model Program development that were considered in this research hinged on a better understanding of the population for whom jurisdictions might implement screening and evaluation activities. Accordingly, a questionnaire was developed and distributed to Driver License Administrators in the 50 United States and 12 Canadian Provinces to broadly establish the cost and time parameters that could influence implementation of Model Program activities, while addressing details of the Model Program concept which conceivably could be impacted by their legal, ethical, or policy implications in each licensing jurisdiction in North America.

A central concern at this point in the project was the potential scope of screening and evaluation programs. Most important was to discover whether, in the opinion of licensing officials, expanded driver screening activities would likely apply to: (a) all drivers over a given age applying for license renewal; (b) only a (presumably much smaller) subgroup of "high-risk" drivers who are referred to the DMV through various sources including physicians, occupational therapists, or other health care professionals, friends or family, social service providers, law enforcement or the courts; or (c) both of these sets of drivers. This primary question was asked first in the survey, and defined the "frame of reference" for licensing officials as they responded to the additional queries.

A total of 16 items were clustered in four groups on the survey: (1) the initial question addressing the potential scope of screening and evaluation activities within a jurisdiction; (2) the feasibility of specific screening program enhancements; (3) the cost justification needed to expand screening activities within jurisdictions; and (4) the time constraints on conducting expanded screening activities.

Methodology

The survey questionnaire was reviewed by NHTSA and by the American Association of Motor Vehicle Administrators (AAMVA) prior to distribution. It was produced as an AAMVA Memorandum on AAMVA letterhead and was mailed to Driver License Administrators in the 50 United States plus Washington, DC, plus the 12 Canadian Provinces existing at the time, under the signature of AAMVA's Director of Driver Services. The survey form is included in appendix B.

Initially, responses were received and tabulated from officials in 58 of the 62 jurisdictions contacted, and a draft summary of results was presented at the AAMVA conference held at Incline Village, NV, in 1997 with a request for corrections to ensure that the information subsequently reported did not misrepresent any Agency's policies or practices. The results reported below reflect corrections received from one jurisdiction, plus data from two additional jurisdictions that returned their surveys after the AAMVA conference, yielding a total of 60 respondents--47 States and the District of Columbia, plus 12 Canadian Provinces.

Results

Results are presented for the 60 AAMVA member jurisdictions participating in the survey by summarizing the number and percentages selecting each response alternative for each item, as follows.

(1) Is it your sense that new/expanded driver screening procedures, if implemented in your jurisdiction, should be applied to (a) all drivers over a specified age who apply for license renewal, (b) only a "high risk" subgroup of drivers, likely to include a disproportionate share of older persons, who are brought to the DMV's attention through various referral mechanisms, or (c) both of these sets of drivers?

Only 6 respondents (10 percent) replied that all drivers over a specified age should be targeted for expanded screening procedures upon application for license renewal (answer a). Responses from the remaining jurisdictions were almost equally divided between alternatives b and c. The larger share of respondents (28 of 60, or 47 percent) replied that the expanded driver screening procedures should be applied to only the "high risk" subgroup (answer b), while 26 of 60 (43 percent) replied that both sets of drivers (answer c) should undergo expanded functional screening.

(2) Please base your responses to the following items on your answer to Question (1) above. Postponing considerations of the cost (of testing equipment and/or test administrators) and time required to conduct test procedures for drivers referred into a Model Screening/Evaluation Program, is it your sense that current policies and priorities in your Department would be make it feasible to:

2a. Extend the practice of graduated licensing, which many states have applied to phase in full privileges for the novice driver, to the older driver as well, by implementing progressively more restrictive licensing actions as an individual's capabilities suffer progressive decline? Would this require a change in legislation?

The majority of the respondents (40 of 60, or 67 percent) answered in the affirmative. The remaining 20 respondents (33 percent) replied that graduated licensing for seniors would not be feasible. Of the 40 respondents who reported that graduated licensing would be feasible, 26 reported that this would require a change in legislation and 14 replied that no change in legislation would be required. Of the 20 respondents who replied that graduated licensing was not feasible, 16 replied that a change in legislation would be necessary, and 4 did not respond to the second half of this question.

2b. Implement a community outreach/public education activity for drivers that would provide information on aging and safe driving practices, techniques for self testing (which could also encourage individuals to refer themselves into a screening/evaluation program), and, when needed, provide advice on transportation alternatives in the individual's home area?

Eighty-five percent of the respondents (50 of 59) responded in the affirmative and 15 percent (9 of 59) responded that this was not feasible.

2c. Implement screening/evaluation program activities wholly within the DMV, or privatize some or all license qualification assessments for passenger vehicles (assuming that standard, certified procedures are implemented uniformly throughout your jurisdiction)? Please choose among: (1) DMV provides all screening activities; (2) DMV provides some screening activities and some are privatized; (3) All screening activities are privatized.

Twenty-seven of the 60 respondents (45 percent) replied that the DMV would provide all screening activities; 38 of the 60 respondents (63 percent) replied that the DMV would provide some screening activities while others would be privatized, and 1 respondent replied that all screening activities would be privatized. It should be noted that responses to these three questions were not mutually exclusive; 6 States/Provinces replied "yes" to the first two items (Alberta, Colorado, Illinois, North Carolina, Vermont, and Washington State), and Oregon responded "yes" to all three items.

2d. Modify existing vision test procedures for drivers who have been referred to the DMV for functional impairment screening, such that acuity is measured using new techniques, provided that they are more accurate and/or reliable?

Seventy-six percent of the respondents (44 of 58) responded that this would be feasible, while 24 percent (14 of 58) replied that it would not. Two jurisdictions did not respond to this survey item.

2e. Modify existing vision test criteria such that lower levels of performance (e.g., 20/80, 20/100, or worse) do not necessarily result in the loss of all driving privileges, but instead may result in restrictions (such as daylight only driving)?

Seventy-two percent of the respondents (43 of 60) replied in the affirmative, while 28 percent (17 of 60) replied that this practice would not be feasible.

2f. Expand vision test procedures to include abilities which are not presently tested (dynamic visual acuity; contrast sensitivity; low luminance acuity) but which have been shown in research to be more strongly related to crash risk than the present (static) visual acuity measure?

Eighty-five percent of the respondents (51 of 60) replied that this practice would be feasible, and 15 percent (9 of 60) responded that it would not be feasible.

2g. Adopt criteria for functional capabilities other than vision as the basis for licensing action (restriction or revocation), which would include--though not necessarily be limited to--measures of attention, perception (of speed and distance relationships), memory and cognition, decision making, navigational problem solving, or "situational awareness"?

Seventy-eight percent of the respondents (47 of 60) responded in the affirmative, while 22 percent (13 of 60) responded that this practice would not be feasible.

2h. Conduct tests to assess functional capabilities for individuals referred into a screening/evaluation program, regardless of when this occurs in the driver's renewal cycle, i.e., without waiting until the end of the current cycle for removal or restriction of driving privileges if warranted by test results?

Ninety-seven percent of the respondents (57 of 59) replied that this practice would be feasible, and 3 percent (2 of 59) replied that this would not be feasible (Massachusetts and Montana). One jurisdiction did not respond to this survey item.

2i. Conform to uniform (national/ North American) standards--to be developed--for referral of drivers into a screening/evaluation program based on the diagnosis of medical conditions including, though not necessarily limited to, dementia (Alzheimer's and other dementias); stroke; Parkinson's disease; seizure disorders; diabetes; heart disease, arrhythmias, and related cardiovascular conditions.

Eighty-six percent of the respondents (50 of 58) replied that this would be feasible, while 14 percent (8 of 58) replied that it would not be feasible. Two jurisdictions did not respond to this survey item.

2j. Tailor retesting requirements (nature and frequency) for license renewal or retention of driving privileges to specific medical conditions (e.g., Alzheimer's, Parkinson's, diabetes), for physician referrals or self reports of medical conditions to the DMV ?

Ninety-two percent of the respondents (55 of 60) replied that this practice would be feasible while 8 percent (5 of 60) replied that it would not be feasible.

2k. Refer drivers who are undiagnosed by a physician, but who are believed by family, friends, and/or others in the health care/social services fields to suffer functional impairment, into a screening/evaluation program, which would mandate subsequent functional tests with the potential for licensing action?

Ninety percent of the respondents (54 of 60) replied that this practice would be feasible while 10 percent (6 of 60) replied that it would not be feasible.

2l. Implement a referral mechanism for functional screening/evaluation in which DMV counter personnel use a checklist to record a brief, structured set of observations, and/or question-and-answer responses, for members of the driving public who appear before them?

Sixty-four percent of the respondents (38 of 59) reported that this practice would be feasible to implement while 36 percent (21 of 59) replied that it would not be feasible. One jurisdiction did not respond to this survey item.

2m. Tailor on-road examination procedures for drivers who have been screened for functional impairment, to the specific area of functional decline which places that individual at greater crash risk--i.e., administer road tests with varying content or areas of emphasis for varying impairments?

Seventy-eight percent of the respondents (47 of 60) indicated that this practice would be feasible, while 22 percent (13 of 60) responded that it would not be feasible.

(3) With specific regard to the cost of new test procedures, to what extent would such costs have to be offset by savings in other Department activities within the short term (present or next fiscal year) to permit implementation? (Check one response):

1. Substantially or completely (100 percent, or close to it) regardless of expected payoffs in improved safety.
2. To a significant extent (50 percent or greater) but not completely, given a solid expectation of measurable safety benefits.
3. Only minimally, or not at all (less than 50 percent, down to zero) if significant safety benefits have been demonstrated in another state or a pilot program.

The majority of respondents (30 of 58, or 52 percent) chose response "a," that costs of new test procedures would need to be offset substantially or completely by savings in other Department activities. The balance of the responses were distributed equally between alternatives "b" and "c." Twenty-four percent of the respondents (14 of 58) indicated that savings would need to be offset to a significant extent (response "b"), while 24 percent of the respondents (14 of 58) chose response "c," that costs would have to be offset only minimally or not at all by savings in other Department activities. Alberta responded that they would only support a user-pay system. Two jurisdictions did not respond to this survey item.

(4) With specific regard to the administration of functional testing requirements as addressed in this survey, what is the practical upper limit on the time of testing within your jurisdiction? (Check one response):

1. under 15 minutes
2. 15 to 30 minutes
3. 30 to 45 minutes
4. d45 minutes to 1 hour (or no limit)

This question produced the most variation in responses, with approximately one-quarter of the respondents choosing each of the four alternatives. Twenty-five percent of the respondents (15 of 59) stated that the upper time limit for testing would be under 15 minutes (response "a"). Twenty-nine percent of the respondents (17 of 59) indicated that testing could feasibly last for 15 to 30 minutes (response "b"). Twenty-five percent (15 of 59) stated that testing could utilize from 30 to 45 minutes (response "c"). The smallest percentage of the respondents (20 percent, or 12 of 59) indicated that testing could last 45 minutes to 1 hour or more (response "d"). Rhode Island did not choose any of the alternatives, and instead responded only that test times vary greatly. One jurisdiction did not respond to this survey item.

Overall, the responses to this survey indicated substantial differences among licensing officials across North America regarding the potential for changing the policies and practices in this area. Current project efforts were encouraged by the consistently large majorities that provided affirmative responses to the series of questions under Item 2 addressing the feasibility of expanded and/or or enhanced screening activities. At the same time, while there is flexibility with respect to the amount of time that an agency could allocate to driver screening, Model Program recommendations are not likely to be implemented unlikely unless the associated costs can be offset "to a significant extent" or completely by savings in other Department activities.

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