Model Driver Screening and Evaluation Program
Volume II: Maryland Pilot Older Driver Study

 

Appendix A.
Maryland Research Consortium 
Goals, Objectives, and Action Steps

Table 10. 
Maryland Research Consortium Goals, Objectives, and Action Steps 
for Working Group 1: Identification & Assessment of High-Risk Older Drivers
Goal Objective Action Steps
A. Identify at-risk older drivers.

 

 
A1. Develop materials to permit those who come in contact with potentially at-risk older drivers to determine the need to have their driving abilities assessed. A1a. Determine who can identify at-risk older drivers and the resources they need. 

A1b. Review/develop materials (e.g., checklists) appropriate for use by non-professionals to monitor driving and detect potential problems; users include older drivers themselves, their friends and families, and a wide range of lay caregivers and service providers in the community. 

A1c. Review/develop materials appropriate for use by professionals to detect potential driving problems; users include health care professionals, law enforcement professionals, and rehabilitation professionals.

A2. Develop a quick, easy-to-administer screen to enable practitioners, including MDs, OTs, PTs, ADED, and others, to reliably assess the most at-risk older drivers. A2a. Comprehensively list and describe tests now used by MDs, OTs, PTs, ADED, and other health professionals and practitioners to evaluate drivers' functional abilities. 

A2b. Relate performance on prior and current administrations of candidate measures to crash data; to over-involvement in moving violations; and to medical/ functional disability referrals to the MVA. 

A2c. Establish preliminary cutoffs for performance on 1st tier/screening measures to trigger 2nd tier tests. 

A2d. See A1a above.

A3. Develop a standard set of screening procedures to enable lay caregivers, DMV line personnel, Area Agency on Aging personnel, and other volunteers/non-professionals, to identify driving limitations; and provide accompanying materials so these personnel can identify who needs more detailed assessment or treatment, and where to obtain it. A3a. Develop a "test kit" of inexpensive materials that can be used in diverse (field) settings. 

A3b. See A1a above. 

A3c. See A2b above. 

A3d. See A2c above.

B. Identify which at-risk older drivers are the best candidates for rehabilitation. B1. Define a standard set of screening/diagnostic procedures to determine whether at-risk older drivers can be rehabilitated. B1a. Review research studies/rehabilitation literature to determine what diagnoses have the potential to be successfully remediated. 

B1b. Review content and protocols of diagnostic tests to determine how functional limitations of at-risk older drivers can be assessed. 

B1c. Develop recommendations for specific test procedures and protocols (hardware & software) and who can/should perform them.

C. Identify which at-risk older drivers can drive in a restricted manner. C1. Define a standard set of screening/diagnostic procedures to determine whether at-risk older drivers need to change their driving patterns/exposure. C1a. Determine from literature what conditions require what kind of driving restrictions. 

C1b. Review research conducted in other states (e.g., Utah) to determine effectiveness of restrictions for specific medical conditions in reducing crash risk. 

C1c. Evaluate the current restriction policy in Maryland to determine whether/what restrictions reduce crash risk, for which drivers. 

C1d. Identify road test components required to determine whether drivers can compensate for their disabilities. 

C1e. See B1c above. 

C1f. Identify research required to develop more objective criteria for driving restrictions.

D. Identify which at-risk older drivers need to stop driving. D1. Define a standard set of screening/diagnostic procedures to identify those who should stop driving. D1a. Determine from literature what driving cessation/license surrender policies and review practices are in place for medical conditions/functional impairment levels. 

D1b. List minimum levels of performance for MVA licensing (e.g., scores on knowledge and vision tests, and on-road driving evaluations). 

D1c. Describe levels of functional impairment or progression of medical conditions at which MAB/other health care providers determine that driving is no longer safe. 

D1d. Identify road test components that clearly indicate individuals who should not drive. 

D1e. See B1c above.

E. Identify and describe functional limitations that would interfere with or preclude use of specific forms of alternative transportation. E1. Develop a matrix relating levels of cognitive and physical capability to alternative transportation and services. E1a. Determine levels of cognitive and physical capability required to use transportation alternatives. 

E1b. Determine who has the ability to use alternative transportation, and the information needed. 

E1c. Determine (with WG III) who provides what alternative transportation options for which populations, particularly the disabled.

 

Table 11. 
Maryland Research Consortium Goals, Objectives, and Action Steps 
for Working Group 2: Remediation and Counseling Contributions to Safe Mobility
Goal Objective Action Steps
A. A mechanism to refer and place at-risk individuals in appropriate remedial treatments, and track treatment outcomes.

 

A1. Produce a matrix of treatments and providers for the population served by each service organization, for each deficit revealed through referral, screening, or diagnostic testing, and description of interrelationships and roles of providers. A1a. Create a list of functional impairments (drawing from the efforts of WG I). 

A1b. Perform a critical review of what conditions are remediable through restoration of functional ability, or adaptation/compensation for functional loss. 

A1c. Develop a list of appropriate agencies, centers, or personnel that address, treat, or train for improvement or compensation for noted deficits/impairments and their interrelationships. 

A1d. Set guidelines for the agency which is to coordinate and orchestrate the evaluation, treatment, remediation, and counseling.

A2. Develop a database, plus administrative protocols, to monitor client status and share information among service providers and the licensing agency. A2a. Identify appropriate software tools to use the Internet for sharing information among all consortium entities, including limited development of input screens as required; perform usability tests.
B. Remediate older drivers whose functional disabilities are correctable.

 

 
B1. Develop guidelines for practitioners, including PTs, OTs, rehab specialists, vision specialists, and other health professionals; and for non-health professionals, including social service personnel, driving instructors, and others who support driver improvement through remediation, education, or skills training. B1a. Review research where available and/or collect case data to determine validity or effectiveness of remediation techniques. 

B1b. List and describe existing or new remediation techniques or procedures, their target populations and application. 

B1c. Survey practitioners to see who can perform what rehabilitation activities. 

B1d. Develop or sponsor a training course for people who remediate older drivers.

B2. Develop curriculums necessary to train appropriate personnel to address remediation and driver training. B2a. Survey and select existing curriculums/ components for training staff to perform driving rehabilitation activities 

B2b. Determine procedures and costs of training the trainers.

B3. Evaluate the feasibility of providing remedial treatments for functional disabilities. B3a. Determine staff qualifications, level of training, equipment & facility needs, course/duration, resulting cost, and reimbursement eligibility for remedial treatments.
C. Counsel older drivers faced with restriction or cessation of driving.

 

 
C1. Develop guidelines for counselors specific to the population served, and to the (older) drivers' deficit(s) as revealed through referral, screening, or diagnostic testing. C1a. Review and evaluate counseling programs for older drivers and their families, and select best examples for present use. 

C1b. Identify what types of information and communications are most appropriate and effective for whom. 

C1c. Establish skill/training requirements for different counseling needs (e.g., practical "how to's" versus clinical depression and related symptoms).

C2. Develop guidelines for recommending driving restrictions. C2a. List and describe recommended changes in driving that follow from identified, non-remediable functional limitations. 

C2b. Identify when drivers who do not comply with a recommendation should be reported to the MVA. 

C2c. See C1b above.

C3. Develop guidelines for recommending driving cessation. C3a. List and describe recommended uses of alternative transportation options that follow from identified, non-remediable functional limitations. 

C3b. See C2b above. 

C3c. See C1b above.

D. Identify mechanism(s) to fund evaluation, training, rehabilitation, equipment purchase, and counseling services re: maintaining safe mobility. D1. Develop a matrix of funding resources, including health care/medical insurance industry participation. D1a. Determine costs. 

D1b. Determine resources. 

D1c. Identify cost savings derived from improved assessment, rehab, and counseling activities. 

D1d. Conduct a cost-benefit analysis. 

D1e. Recommend appropriate cost-reduction strategies.

 

Table 12.
Maryland Research Consortium Goals, Objectives, and Action Steps 
for Working Group 3: Mobility Options for Individuals 
Facing Driving Restriction or Cessation
Goal Objective Action Steps
A. Determine the mobility needs of those who must reduce or stop driving.

 

 
A1. Identify which mobility needs are being met, and how. A1a. Review existing information, and if necessary, conduct survey through Area Agencies on Aging to document mobility needs and desires of older clients. 

A1b. Analyze the attributes that contribute to adequacy/desirability of mobility options for "satisfied" clients.

A2. Identify which mobility needs are not being adequately met, and why. A2a. See A1a above. 

A2b. Develop a list of needs that are not being met (e.g., seniors in Montgomery County who cannot find ways to travel to Johns Hopkins in Baltimore for medical treatments).

A3. Compile the information in formats which will be of most use to providers, seniors, and family members.  
B. Identify mobility options at the local level.

 

B1. Develop an inventory of all mobility resource options in communities across the country and in Maryland counties where pilot studies will be initiated. B1a. Compile an inventory of resources, usage, and contacts by community (as providers, brokers, clearinghouses). 

B1b. Contact relevant agencies that deal with senior transportation (both formal and informal) and alternative services (e.g., in-home delivery services). 

B1c. Inventory senior community living facilities that provide transportation for residents (for individuals who would benefit most by relocation to improve mobility). 

B1d. Contact foundations (e.g., Robert Wood Johnson) to identify mobility programs they support.

B2. Evaluate best practices among currently available options. B2a. Survey seniors and family members to determine how currently-used options are accessed. 

B2b. Survey seniors and family members to determine why currently-used options are selected.

C. Develop mobility options information and guidelines, and disseminate to groups/agencies in need of such information.

 

C1. Determine which information (re: mobility options) will be of most use to providers, seniors, and family members in pilot study counties, and present in the form of guidelines to foster best practices in local areas. C1a. Investigate structure of service provision in the selected communities. 

C1b. Determine if structure for this project must be the same in each community or if it is more practical to utilize existing resources. 

C1c. Determine which structures have the maximum potential for success (such as AAA, MVA, central clearinghouse such as Connect-A-Ride, county I&R services) based on past performance where possible. 

C1d. For all structures, determine capabilities of service providers to perform mobility counseling - type of personnel, time requirements, office space, etc. 

C1e. For all structures, identify methods by which clients can access mobility providers, particularly informal providers. 

C1f. Develop needed job specifications, training reqs., materials, etc.

C2. Prepare information for dissemination. C2a. Identify the specific groups to whom the information will be targeted. 

C2b. Identify the specific provider contacts who will disseminate the information. 

C2c. Insure content is consistent with requirements of providers. 

C2d. Format information in such a way to be helpful to providers and seniors.

D. Update database on mobility options and guidelines.

 

D1. Develop central database containing all information re: mobility options, that is flexible enough to compile reports in a variety of formats, building on closely related efforts (e.g., Maryland FTA project) to the greatest extent possible. D1a. Develop database. 

D1b. Develop methods and formats to disseminate database information to appropriate sources. 

D1c. Develop effective means of updating information on a frequent basis. 

D1d. Develop ways to relay this updated, local information back to the central database.

D2. Develop quality control methods. D2a. Develop standard intake form for all "clients" receiving data, regardless of location. 

D2b. Develop quality-of-service survey for providers. 

D2c. Develop quality-of-service survey for the recipients.

E. Secure best resources to ensure safe mobility.

 

E1. Identify what new funding and/or human resources are needed to maintain and enhance safe mobility options. E1a. Assess unmet needs in each community. 

E1b. Determine if current structures can be enhanced to meet these needs or if new options are needed. 

E1c. Develop detailed description of new service to meet needs that cannot be addressed though enhancement of existing options. 

E1d. Identify stakeholders in community and determine extent to which they will support new options. 

E1e. Develop ways to relay updated local information back to the central database.

E2. Determine sources of funding. E2a. Investigate various payment and funding options: users, families, insurance, business, HMO's, etc. 

E2b. Investigate use of volunteers, including coordinating agencies and foundations.

 

Table 13.
Maryland Research Consortium Goals, Objectives, and Action Steps 
for Working Group 4: Public Information & Education Campaign
Goal Objective Action Steps
A. Provide a broad social awareness that loss of mobility is a serious health and quality of life issue for older people.

 

A1. Market the goal to citizens and professionals alike. A1a. Develop PR materials which illustrate how maintaining safe mobility is central to maintaining physical and mental health in old age. 

A1b. Identify a spokesperson(s) to deliver our message.

A2. Develop an educational campaign on the varied impacts of loss of mobility for seniors. A2a. Identify and estimate the changes in physical and mental status that are associated with declining mobility and social isolation. 

A2b. Identify available PI&E resources and determine additional needs to attain the goal. 

A2c. Create campaign content, implementation strategy, and evaluation plan.

B. Provide a broad social awareness that a scope of driving that is inappropriate to an individual's functional abilities is a serious public health issue.

 

B1. Market the goal to citizens and professionals alike. B1a. Develop PR materials which illustrate how safe mobility lowers costs to society while improving quality of life for seniors. 

B1b. Identify a spokesperson(s) to deliver our message.

B2. Develop an educational campaign on the impact of age-related diminished functional capabilities on driving. B2a. Identify and estimate the magnitude of driving risks that result from functional impairments.

B2b. Identify available PI&E resources and determine additional needs to attain the goal. 

B2c. Create campaign content, implementation strategy, and evaluation plan.

C. Dissemination of tools supporting widespread, effective identification & evaluation of declining abilities to drive by older persons themselves; by their health care providers; by their families and friends; and by other senior support professionals or volunteer organizations.

 

C1. Develop materials describing functional limitations & assessment techniques suitable for dissemination to each group targeted in goal statement. C1a. Incorporate information needs identified by other MRC Working Groups into requirements for PI&E materials. 

C1b. Identify education and evaluation materials developed by other agencies or traffic safety organizations. 

C1c. Select/combine most appropriate content and best formats and media. 

C1d. Identify commercial sites (e.g., pharmacies, grocery stores, etc.) most frequently-visited by target population, for distribution of materials. 

C1e. Identify service providers (e.g., physicians and other health care facilities, senior citizen centers, driver license centers) most frequently-visited by target population, for distribution of materials.

C2. Develop support materials meeting the needs of those who counsel older drivers. C2a. Review/select current best practices to identify functional limitations and their influence on safe driving and/or use of transportation alternatives. 

C2b. Review/select best practices to direct those who come in contact with older drivers on how to get help for further (diagnostic) assessment.

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