Standards for driving assessments and vehicle modifications
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Standards for driving
assessments and
vehicle modifications
This standard applies to occupational therapists
holding a practising certificate in New Zealand, and who
provide driving and vehicle modification assessments.
22-28 Willeston Street, 6011
P O Box 9644, Marion Square
Wellington 6141, New Zealand
T: +64 4918 4740
E: enquiries@otboard.org.nz
W: otboard.org.nz
March 2022Standard: driving assessments and
vehicle modifications
1. Introduction strategies. Concurrently, specialist
occupational therapy driving assessors may
also engage in passenger transport
Driving is considered an instrumental activity
mobility for children and adults with
of daily living (IADL). It involves a complex
cognitive or locomotor injury or disability
collaboration of motor perceptual, sensory
(Di Stefano, Stuckey, Kinsman &
and cognitive skills. For the driving task,
Lavender, 2019). Occupational therapists
individuals must simultaneously interact with
provide overview and support in design and
the motor vehicle and the external
project management for travelling safely
environment (Fields & Unsworth, 2017;
as a passenger in a vehicle. Advice may
Patomella & Bundy 2015).
involve basic assistive devices or complex
vehicle modifications and adaptations. An
Determining the safety of drivers requires a
awareness and knowledge of the Ministry of
comprehensive understanding of driving as an
Transport: Land Transport Vehicle
occupation and knowledge of the range of
Compliance Rule: Low Volume Vehicle
legal implications including the Land Transport
Standard 45-60 and Low Volume Vehicle
Act (1998) Section 18 and the Land Transport
Standard 45-30 supports and guides this
(Driver Licensing) Rule 1999, Part 7, Part 9,
process.
and Part 13. Waka Kotahi, the New Zealand
Transport Agency, enacts the driver licence
Occupational therapists are aware of the
process and acknowledges the role of
high priority individuals give to their driving
occupational therapists as specialists who
independence and of the associated
undertake medical fitness to drive
complexity in determining fitness to drive
assessments.
(Yuen & Burik, 2011). The severity of a
serious adverse event occurring during the
2. Scope task of driving or when travelling as a
passenger in a vehicle is potentially high
This standard applies to occupational and holds inherent risks to the safety of the
therapists who have a practising certificate in individual and the general public.
New Zealand and who provide driving,
passenger and vehicle modification The Occupational Therapy Board of New
assessments. Zealand (OTBNZ) has developed these
standards as an adjunct to the
The objective of occupational therapy Competencies for Registration and
engagement for the driving role is to Continuing Practice as part of its role to
determine whether a person has the assure the public will receive a safe,
necessary skills required to commence, competent occupational therapy service.
continue, or return to safe and independent
driving. Standards can be legally enforceable and
used as a benchmark for reviews of
The aim of driver rehabilitation is to facilitate competence and conduct by the OTBNZ
or enhance safe and independent driving, or the Health and Disability
including the provision of adaptive driving Commissioner if necessary. Other
equipment and teaching of compensatory standards which are also applied are the
PAGE 2Standards: driving assessments and
vehicle modifications
OTBNZ Code of Ethics and the Health and provide clear written information to the
Disability Commissioner (Code of Health and client. This should be provided prior to pro-
Disability Services Consumers’ Rights) viding service wherever practicable. Infor-
Regulations 1996. mation provided must:
OTBNZ also seeks to honour Te Tiriti o Waitangi a. State the purpose of assessment, the
in its regulatory activity and expects all process, type and duration of assessments
occupational therapists to understand and work undertaken, and how the results will be
with Te Tiriti as an overarching guide for communicated. This must include
practice. It is anticipated that these standards information about off and on road
will be reflected and supported by the assessments.
organisation’s policies and procedures.
b. Provide client specific information
regarding the service’s assessment
3. New Zealand law components and processes.
The references below are provided as an c. Provide information about the cost of
indication that other legislation may relate to the assessment with responsibility for
the work of practitioners in this area. payment clearly explained. Provision
of a written quote, cost invoice and
• Consumer Guarantees Act, 1993, Part 4 receipt must be provided. Fees and fee
Supply of Services structures must be responsive to clause
• Land Transport (Driver Licensing) Rule 2.2 in the OTBNZ Code of Ethics.
1999, Part 7, Part 9 and Part 13
• Medical Aspects of Fitness to Drive: A Guide d. Practitioners must be clear about their
for Health Practitioners role in respect to advice where clients are
• Fair Trading Act, 1986, Part 2 Consumer purchasing a vehicle and/or adaptive
Information Standards equipment from a third party.
• Health Practitioners Competence Assurance
Act 2003 e. Where appropriate, provide information
• Health and Disability Commissioner for clients to make them aware of their
(Code of Health and Disability Services options for a second opinion, reassessment,
Consumers’ Rights) Regulations 1996 and complaint processes.
• Health and Safety at Work Act 2015
• Land Transport Act 1998 – Section 18, 4.2 Assessments are collaborative and
Section 19, Section 106; Land Transport proactive. Communication occurs with
Amendment Act 2017 referrers and / or may include the Waka
• Ministry of Transport: Land Transport Kotahi Medical Review Section, ACC, other
Vehicle Compliance Rule: Low Volume health professionals, and/or insurers.
Vehicle Standard 45-60 and Low Volume Driving instructors, vehicle modification
Vehicle Standard 45-30 engineers, technicians and/or sales
• Vulnerable Children Act 2014 representatives may also be involved.
• Privacy Act 2020.
4.3 Informed consent1 must be obtained in
conjunction with information contained
within clauses 4.1 and 4.2 will include:
4. Overview
a. The collection of personal information.
4.1 Occupational therapists involved in driving, 1 Informed consent is defined in Right 7 of the code of
passenger and vehicle assessment must health and disability service user’s rights: Right to make an
PAGE 3 informed choice and give informed consent.Standards: driving assessments
and vehicle modifications
5.1 Off-road assessment
Privacy statements with clear information and The off-road clinical assessment involves
details for the sharing and disclosure of the following:
findings and advisory recommendations of
assessment. 5.1.1. Medical fitness
Referral to assessment services should
b. Outcome and recommendations that must include medical history in order for the
be communicated to the clients’ general assessor to identify signs and symptoms of
practitioner. It should be made clear to the pathology, contraindications and
client which, and why, agencies will receive the precautions for driving. Any condition/s
results of the assessment. likely to impact safe driving capacity or
travelling as a passenger is
c. Any statutory requirements to inform Waka comprehensively and appropriately
Kotahi NZTA or other parties about the evaluated during the screening, interview
outcome of the assessment. and assessment process.
Particular attention should be made to Occupational therapists will review
ensure appropriate informed consent for clients referals received and determine suitability
with any cognitive impairment. of a client including ethical responsibilities
and considerations before accepting or
4.4 It is essential that practitioners maintain providing a service. When medical
records of the complete process and interactions information is not provided at the time of
with the client. Information that is not referral, the occupational therapist will
completed at the time or a short time after the make reasonable efforts to obtain this
service should be recorded as such. information.
a. Driver’s licence recommendations will be spe- 5.1.2 Occupational therapists will
cific, reasonable and enforceable. Consideration consider any condition/s likely to impact
will be given to reassessment of driving over a safe driving capacity or travelling as a
set period based on the clinical judgement of the passenger is comprehensively and
assessor. appropriately evaluated during the
screening, interview and assessment
b. It is essential that practitioners maintain re- process.
cords of the complete process and interactions
with the client. Information that is not complet- 5.1.3 Occupational therapists will complete
ed at the time or a short time after the service assessments with regard to the medical
should not be recorded as such. policies and standards contained in the
Waka Kotahi NZ Transport Agency
document: Medical aspects of fitness
5. Assessment Framework to drive: A guide for health practitioners.
There is a wide range of potential deficits sub- 5.2 On-road practical drive
sequent to illness, injury or disability which may A valid driver’s licence is essential for
compromise driving safety. Occupational legally driving on New Zealand roads.
therapists use a client-centred approach and are Findings from the off-road assessment
required to evaluate and render an opinion on should support progression to on-road
driving safety or potential, including prescription driving. If the practical drive is
of vehicle modification. The following factors contraindicated by findings from the off-
determine appropriate assessment protocols: road in-clinic assessment, then the client
can reserve the right to proceed to an on-
PAGE 4Standards: driving assessments
and vehicle modifications
road assessment, provided that this may be ting adaptive equipment.
done in a safe and controlled environment.
5.3.2 The occupational therapist is
5.2.1. A suitably qualified driving instructor is responsible for ensuring whānau/carers
included in on-road assessments when can safely use all equipment provided,
appropriate. The driving instructor is briefed by ensuring ongoing safety of the passenger.
the occupational therapist prior to
commencement and an appropriate route is 5.4 Where modifications to the vehicle are
chosen based on findings from off-road required the occupational therapist will
assessment and the client’s usual driving complete an on-road assessment in a mod-
practice. The practitioner and the driving ified vehicle enabling the driver to trial the
instructor share responsibility for safety during prescribed equipment. Where this is not
the assessment and should ensure that they practically possible the occupational ther-
have overlapping policies and procedures for apist will provide sound clinical reasoning
managing any identified risk prior to the to justify recommendeding vehicle modifi-
on-road assessment commencing. Both the cations without prior on road assessment.
driving instructor and the occupational The occupational therapist will provide
therapist have responsibility to end the recommendations regarding driver rehabil-
assessment where an immediate risk of harm itation. Reassessment to confirm the client
to the occupants or public is identified. has demonstrated a safe level of driving
will be conducted when appropriate.
5.2.2. The occupational therapy service must
have written protocols regarding the use of 5.4.1. The occupational therapy service
an assessment vehicle for the purposes of an must have written protocols regarding
on-road practical drive or whether the client’s driver rehabilitation. The aims and purpos-
own vehicle can be used. A dual control vehicle es should be set by the occupational ther-
should be used where indicated by the off-road apist with regular progress updates from
and risk assessment. Vehicles must have a the driving Instructor to enable timely
current warrant of fitness and registration, reassessment.
have operating seat belts for the driver and
passengers and display appropriate licence
plates. This information needs to be provided 6. Education and qualifications to
to the client prior to any assessment taking conduct assessments
place.
OTBNZ recognises there is no formal
5.3 Passenger assessment educational programme in New Zealand
Passenger assessments need to include the which qualifies occupational therapists to
following: conduct medical driving, passenger or
vehicle modification assessments. Instead
5.3.1 The occupational therapist has a range of pathways for occupational
responsibility for ensuring wheelchair securing therapists who conduct driving,
and access equipment meets present clinical passenger and modification assessment
requirements and all legal and safety currently exist.
regulations. Consideration should be given to
the future needs of the client to ensure the 6.1. Learning through supervision and
equipment provided meets long term needs mentoring from an experienced
wherever possible. This may require liaison occupational therapy driving assessor.
with the clients wheelchair and seating Driving assessors will have engaged in
therapist and the engineer responsible for fit- continuing professional development such
PAGE 5Standards: driving assessments
and vehicle modifications
as attendance at driving assessment 7.2 The practitioner’s ePortfolio should reflect
conferences, designated courses, appropriate levels of professional
submissions to professional publications, development related to driving assessment as
and engagement in driving assessment part of every two year cycle.
forums. Experienced occupational
therapists are expected to evidence 7.3 The requirement to hold professional
continued professional development and indemnity insurance must be considered by
ongoing learning in their OTBNZ ePortfolio. the practitioner.
6.2 International study must be applicable 7.4 Occupational therapists must have
for driving, passenger and vehicle ongoing professional engagement with the
modification competency relevant to the occupational therapy profession and
New Zealand context, including legislation, demonstrate current evidence-based best
funding bodies and government. A practice relating to driving assessment in
period of supervision and mentoring from New Zealand. Belonging to a professional
an experienced driving assessor is required association may be advantageous.
to adapt international training to the New
Zealand context appropriately. Adaption 8. Resources
of international training and assessment
processes needs to incorporate and align 8.1 Additional information about providing
with the Competencies for Registration and specialised services as an occupational
Continuing Practice for occupational therapist can be found in the OTBNZ Position
therapists. Statement: Practice Boundaries for
Occupational Therapists and Practice
6.3 Some organisations and agencies Boundaries for Occupational Therapists: A
offer Guide for Practitioners.
credentialing for practitioners. It is the
practitioners’ responsibility to identify the
credentialing required for the scope of
Related resources
their role.
Accident Rehabilitation and Compensation
Insurance Act 1992; The Accident
6.4 It is expected that driving assessors
Compensation Act 2001; Injury
will be familiar with the New Zealand road
Prevention, Rehabilitation and
code and have held a full class 1 licence for
Compensation Amendment Act (No 2) 2008;
at least two years.
The Accident Compensation
Amendment Act 2010
7. Professional responsibilities
American Occupational Therapy
7.1. To ensure ongoing competence occu- Association (AOTA) Evidence Based
pational therapists must have appropriate Consensus Statements for Driving and Com-
supervision. Best practice will involve regu- munity Mobility (2016)
lar formal supervision from an occupational
therapist who is an experienced driving Canadian Association of Occupational Thera-
assessor or has active engagement with pists (CAOT) Position Statement
ongoing professional development related Occupational Therapy and Driver
to driving, passenger and / or vehicle Rehabilitation (2009)
modification assessment.
PAGE 6Health and Disability Commissioner: The Patomella, A.-H., & Bundy, A. (2015).
Code of Health and Disability Services Con- P-Drive:
sumers Rights Implementing an assessment of on-
road driving in clinical settings and
Ministry of Transport: Land Transport investigating its internal and predic-
Vehicle Compliance Rule: Low Volume tive
Vehicle Standard 45-60 and Low Volume validity. American Journal of Occupa-
Vehicle Standard 45-30. Low Volume tional Therapy, 69, 6904290010. http://
Vehicle Technical Association (LVVTA dx.doi.org/10.5014/ajot.2015.015131
Certification)
Yuen, H. K., & Burik, J. K. (2011). Brief
Occupational Therapy Australia (OTA): Report-
Position Paper: Occupational therapy in Survey of driving evaluation and
driver assessment and rehabilitation (2015) rehabilitation curricula in occupation-
al therapy programs. American Journal
Occupational Therapy Australia (OTA): Aus- of
tralian Competency Standards for Occupa- Occupational Therapy, 65,217-220. doi:
tional Therapy Driver Assessors (2018) 10.5014/ajot.2011.000810
Occupational Therapy Board of New
Zealand: Code of Ethics for Occupational
Therapists (2015); Competencies for
Registration and Continuing Practice
(2015).
Vulnerable Children Act, 2014
References
Di Stefano, M., Stuckey, R., Kinsman, N.
(2019).
Understanding characteristics and
experiences of drivers using vehicle
modifications. American
Journal of Occupational Therapy.
3(1):7301205050p1-7301205050p9. doi:
10.5014/ajot.2019.023721
Fields, S., & Unsworth, C (2017). Revision
of the Competency Standards for Oc-
cupational Therapy Driver Assessors:
An overview of the evidence for the
inclusion of cognitive and perceptual
assessments within fitness-to-drive
evaluations. Australian
Occupational Therapy Journal 64, 328–339
doi: 10.1111/1440-1630.12379
Standard approved by the Occupational
Therapy Board of New Zealand 15 June 2021
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