Date Presented 03/27/20
This study sought to update the CHSA to ensure compliance with modern safety and technology expectations. OTs completed an online survey to suggest changes to the CHSA 4.0’s 78 criteria. Modifications included wording and content changes in more than half of the items, as well as more detailed instructions. This process resulted in the CHSA 5.0, available at: https://www.misericordia.edu/uploaded/documents/academics/ot/chsa_5.0_April_11_2019.pdf.
Primary Author and Speaker: Grace Fisher
Additional Authors and Speakers: Haley DiMassimo, Caroline Florenzo
Contributing Authors: Rebecca Burgess, Bailee Hymers, Kaitlynn Kuchta, Olivia Natale
BACKGROUND: According to the National Safety Council (2019), preventable injuries in the home are at an all-time high, ranking as the third leading cause of death in the U.S. The Council reported there were 90,200 deaths in the home in 2017, making up 53.1% of overall preventable-injury related deaths. The leading cause of injuries to older adults is falls, which resulted in 27,000 deaths in 2014 (Center for Disease Control and Prevention [CDC], 2016). Other home accidents, sometimes fatal, include fire and carbon monoxide poisoning. Comprehensive home safety assessments are essential for the prevention of accidents such as these, as they can lead to removal of fall hazards, proper storage of dangerous items, and improved adherence to safety precautions. A series of nine instrument development studies and field tests led to the ongoing development of the Cougar Home Safety Assessment (CHSA). The studies were instrumental in demonstrating the CHSA’s content validity, inter-rater reliability, and usefulness in identifying safety hazards in the home. They are referenced at: https://www.misericordia.edu/page.cfm?p=1266
The most recent CHSA journal publication resulted in the development of the CHSA 4.0 and demonstrated its usefulness in achieving positive safety outcomes in the homes of older adults (Fisher, Bradley, Costulas, Kintner, Kozlevcar, Mahonski, . . .Stine, 2008). Since that time, safety expectations have evolved. Therefore, it is important to update the CHSA to ensure its compliance with technological changes.
PURPOSE: The purpose of this study was to consult practicing occupational therapists to critique CHSA criteria and then develop a new version of the CHSA. The investigators sought to assure that criteria in the new version were in keeping with home safety advancements and occupational therapist expectations. Research questions which this study sought to answer were: How would the therapists rate the appropriateness of each of the 78 criteria? What recommendations would the therapists give for altering the CHSA?
DESIGN: This instrument development study used an on-line survey to ask occupational therapists to rate items as “acceptable” or “needs revision.” It also invited comments and suggestions for any needed criterion changes in the CHSA.
METHOD: A total of 641 alumni from a university’s occupational therapy master of science degree program were surveyed online to obtain feedback and recommendations concerning the appropriateness of the CHSA 4.0 criteria.
RESULTS: All data from the 28 respondents were summarized in a table and analyzed both quantitatively and qualitatively by all researchers, via in-depth examination and discussion of all recommendations pertaining to each criteria. Revisions to 48 of the 78 items on the CHSA were made, resulting in the revised instrument. Improvements in wording, clarity, and technological advancements were made in this process. The new CHSA 5.0 also includes instructions noting the importance of therapist judgment when assessing the home, as well as an area to document recommendations.
DISCUSSION: Occupational therapists are advised to complete detailed home safety assessments. Ongoing instrument development studies demonstrate the CHSA 5.0 is a valuable tool in home safety assessment. It is hoped its use will contribute to a decrease in the number of preventable injuries at home, including but not limited to injuries from falls, smoke and carbon monoxide inhalation, firearms, poisoning, and naturally occurring disasters.
CONCLUSION: This investigation provides evidence of the content validity of the CHSA 5.0. It is recommended that clinicians consider its unique emphasis on environmental safety in the home. It is available for download at: https://www.misericordia.edu/page.cfm?p=1266.
References
Centers for Disease Control and Prevention. (2016). Falls and fall injuries among adults aged ≥65 years — United States, 2014. Retrieved from https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm
Fisher, G., Burgess, R., DiMassimo, H., Florenzo, C., Hymers, B., Kuchta, K., Natale, O. (2019). Cougar Home Safety Assessment (CHSA) 5.0. Retrieved May 2, 2019 from https://www.misericordia.edu/page.cfm?p=1266
Fisher, G, Bradley, E., Costulas, D., Kintner, L., Kozlevcar, J., Mahonski, K., McMenamin, K., Rompilla, A., Woods, J., & Stine, J. (2008). Home modification outcomes in the residences of older people as a result of Cougar Home Safety Assessment (Version 4.0) recommendations. Californian Journal of Health Promotion, 6(1), 87-110.
National Safety Council. (2019). All injuries. Retrieved from https://injuryfacts.nsc.org/all-injuries/overview/
