Title and acronym
Westmead Home Safety Assessment (WeHSA).
Author and date published
The author of the WeHSA is Lindy Clemson.
The first version of the assessment tool was developed in 1989, however, it was not published until 1997.
Screen or comprehensive evaluation
The WeHSA is a Comprehensive assessment in that it aids the Occupational Therapist to thoroughly identify fall hazards in and around the home of the client.
Intended population
The WeHSA is intended for use in the Elderly population.
Constructs assessed by the WeHSA
A lack of home environment specific fall hazard identification assessment tools led to the development of the WeHSA which focusses on fall hazards specifically in the home (Clemson, 1997).
How findings can be reported
The WeHSA is a criterion referenced assessment (Clemson, 1997).
Assessment tool administration
Duration of assessment
The WeHSA itself is manageable in a home visit (1 hour), however, further assessments should be conducted to complement the WeHSA and to gain a more thorough insight into the client’s position. These added assessments include;
- History of falls
- Safe practices and risk-taking behaviour
- Lifestyle eg. A client living in an apartment will have different risk factors to a client living on acreage.
- Usual patterns of usage in areas of the home
- Anthropometrics – body dimensions and size
- Mobility
- Cognitive assessments
- Functional vision
Overview of how to administer the WeHSA
Prior to assessing client’s homes using the WeHSA, the Occupational Therapist should read and familiarise themselves with the manual. Alternatively, training is available in the use of the WeHSA tool (Clemson, 1997). It is also a good idea to practice using the WeHSA in the Therapist’s own home (Clemson, 1997).
A flowchart (adapted from Clemson, 2016) briefly outlining how best to conduct the WeHSA has been included for clarification by the Occupational Therapist. Included in the appendix of this overview is a copy of the WeHSA long form so that the therapist can appreciate the comprehensive nature of the assessment in recognizing fall risk factors in the home.
Psychometric properties of the WeHSA tool
Reliability
A paper by Clemson, Fitzgerald, Heard, and Cumming (1999) established that the WeHSA had a high level of inter-rater reliability with 34 items having an excellent rating (kappa>0.75), 31 items having a fair to good rating (0.75> kappa >0.40) and zero items having a poor rating (kappa<0.40).
Validity
- Face validity – Feedback from therapists in the clinical use trial determined that the WeHSA had a high level of face validity. ‘They reported that it flowed and was logically presented, … useful and well-formatted’ (Clemson, L. 1997, p.38).
- Content validity – As the WeHSA is a criterion referenced tool, content validity is integral to the to the assessment’s success. Otherwise, the therapist could not be sure that the domain of content is adequately covered (Popham, 1978, as cited in Clemson, 1997).
In a study by Clemson, Fitzgerald, and Heard (1999), a panel of experts concluded that the WeHSA has a high level of content validity. Content validity was first established in the initial stages of the tool’s development. A panel of four occupational therapists with expertise in the areas of home assessments, physical dysfunction and geriatrics came together, over a six-month period, to produce a comprehensive list of potential hazards within the home (Clemson, 1997).
The rationale for the content validity of the WeHSA was derived from an extensive review of the literature of the time into the role the environment plays in falls, ‘the nature of falls and the nature of environmental hazards’ (Clemson, 1997, p.38). At each stage of the content validity progression, the WeHSA was reviewed and refined to ensure it adequately identified possible falls risks around the home (Clemson, 1997).
Outcomes provided
The WeHSA is a criterion referenced assessment tool. It is designed to give baseline measures in relation to potential fall hazards within the client’s home. It is not graded against a population and therefore does not have normative data.
Clinical utility
Strengths and limitations of the WeHSA
The WeHSA is a user-friendly tool that provides a comprehensive guide to identifying home fall hazards. It is practical and requires no special equipment to complete it.
The WeHSA tool does not consider individual factors unique to each client and consequently should not be used in isolation, as it does not provide any insight into how the client interacts with their environment. Care should therefore be taken when analysing the results of the test. As previously mentioned, several further assessments should be conducted alongside the WeHSA to fully understand the client’s risk of falling.
The 1997 research behind the WeHSA was conducted in Australia (Clemson, Roland, & Cumming), a culture that values living independently, however, assumptions should not be made as to whether the client values living independently in their home. As in all professional practice, this assessment should only be done with the consent and collaboration of the client.
Decisions regarding the safety of the environment are left entirely to the discretion of the therapist, therefor they should be well-versed in the domain of fall hazards within the home (Clemson, 1997). If the home is not thoroughly and correctly assessed, clients may have an increased risk of falling.
Similar assessment tools and approaches
There are several tools that can be used in place of the WeHSA.
- HOME FAST – Developed as part of a preventative health assessment (Mackenzie, Byles, & Higginbotham, 2002), however it is a screening tool only and should not be considered definitive in its evaluation.
- SAFER tool – A comprehensive tool used to identity falls risks in the home. It not only focuses on environmental factors but also the client’s ability to live safely in their home (Backman, 2002).
- Home Safety Self-Assessment Tool (HSSAT) – A comprehensive guide to preventing falls within the home for older adults and/or their caregivers. It also includes information on products and service providers available to improve safety in the home (Tomita, Saharan, Nochajski, & Schweitzer, 2014). However, the tool was developed in America so this information may not be transferable to other older adult populations.
References
- Backman, C. (2002). SAFER tool: Safety assessment of function and the environment for rehabilitation. The Canadian Journal of Occupational Therapy, 69(5), 303. Retrieved from https://search-proquest-com.ezproxy.usc.edu.au/docview/212910589?accountid=28745
- Clemson, L. (1997). Home fall hazards: A guide to identifying fall hazards in the homes of elderly people and an accompaniment to the assessment tool, the Westmead Home Safety Assessment (WeHSA). West Brunswick, Australia: Co-ordinates Publications
- Clemson, L. (1997, 2015). Falls prevention: Westmead home safety assessment long form. Retrieved from Fall Prevention Online Workshops: http://www.fallspreventiononlineworkshops.com.au/wp-content/uploads/2016/08/HomeSafetyAssessment-Long-Form-Jan-2015.pdf
- Clemson, L., Roland, M., & Cumming, R. (1997). Types of hazards in the homes of elderly people. The Occupational Therapy Journal of Research, 17(3), 200-213. Retrieved from https://search-proquest-com.ezproxy.usc.edu.au/docview/907251129?accountid=28745
- Clemson, L., Fitzgerald, M., Heard, R. & Cumming, R. (1999). Inter-rater reliability of a home fall hazards assessment tool. The Occupational Therapy Journal of Research, 19(2), 83-98. doi: 10.1177/153944929901900201
- Clemson, L., Fitzgerald, M. & Heard, R. (1999). Content validity of an assessment tool to identify home fall hazards: The Westmead Home Safety Assessment. British Journal of Occupational Therapy, 62(4), 171-179. doi: 10.1177/030802269906200407
- Clemson, L. (2016). Reducing environmental and behavioural fall hazards: The Westmead approach to assessment and intervention. Retrieved from Fall Prevention Online Workshops: http://www.fallspreventiononlineworkshops.com.au/wp-content/uploads/2016/08/Westmead-schema-2016.pdf
- Mackenzie, L., Byles, J., & Higginbotham, N. (2002). Reliability of the Home Falls and Accidents Screening Tool (HOME FAST) for identifying older people at increased risk of falls. Disability & Rehabilitation, 2002, 24(5), 266-274. doi: 10.1080/09638280110087089
- Tomita, M., Saharan, S., Nochajski, S., & Schweitzer, J. (2014). Phsychometrics of the Home Safety Self-Assessment Tool (HSSAT) to prevent fall in community-dwelling older adults. American Journal of Occupational Therapy, 68(6), 711-718. doi: 10.5014/ajot.2014.010801
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