The Establishment of the 3-Tier Assessment System - Essay Example

A proposal for the Establishment of 3-Tier Assessment System for Old Drivers (Insert your name here) (Insert your reg. number here) PSYC 3020 (Semester xxx, 2013) School of Psychology, The University of Queensland Tutors: (insert their names here) Word count (not including references): 2141 Executive Summary Establishment of 3-Tier Assessment System needs to be adopted for the evaluation of old drivers. The number of crashes caused by older drivers is currently not a major road safety issue in Australia. Nevertheless, demographic composition of the driving population of Australia is changing. This suggests a need for urgent strategy that reduces cases of car crash for old drivers. The system aims at identifying impairment, and prolonging safe driving years. This proposal finds that other test such as medical testing, re-evaluation of test techniques, and withdrawals of drivers’ license have become ineffective. I therefore propose incorporation of the 3-Tier Assessment System which will consist of a tiered series of assessment and screening tools. The Tier 1 tool will be memory recall screening, two vision tests (contrast sensitivity and visual acuity). The Tier 2 will be Perceptual Response Test (PRT). The Tier 3 is on-road drive test consisting of Area Driving Performance Evaluation. Evaluation of test effectiveness will be done using two groups of old drivers with prior violation records known. One group will take the 3-Tier Assessment System then evaluation done after the assessment. This will be compared to ascertain the difference between the two groups. Proposal for the Establishment of 3-Tier Assessment System for Old Drivers The system consist of test battery that asses renewal applicants of old age to ascertain if, from the date of the original licensure, they have adverse mental, visual or physical frailty that need test evaluations (Janke et al., 2003). Researches regarding effectiveness of 3-Tier Assessment System have been twofold; some arguing for while others finding the system necessary. For instance, early pilot studies have shown the need for further testing and refinement of the Tier 2 and Tier 3 (Janke & Eberhard 1998; Hennessy & Janke, 2005; Hennessy & Janke, 2009). On the other basis of findings, there is argument that the system helps old drivers with difficulties such as fatigue, and visual impairment (Fisk et al., 2002; Mazer et al., 2003). Contemporary researches have began linking 3-Tier Assessment System with patterns of crash risk associated with drivers within the age bracket of 55-80 years (Horswill et al., 2008). Another school of thought is claiming that implementation of 3-Tier Assessment System well help reverse visual and cognitive declines witnessed in drivers over the age of 75 years (Florida At-Risk Driver Council, 2004). From the literature and pilot studies cited, 3-Tier Assessment System has higher chance of detecting cognition, vision, physical and coordination inabilities possessed by old drivers. Recent meta-analyses and reviews on how 3-Tier Assessment System can detect the above frailties quite extensively (Dobbs, 2005; Cheung & McCartt, 2011). Tests have been carried out to come up with measures of controlling old age related car crashes. It therefore means that establishment of 3-Tier Assessment System will not only be life-saving project but also a model aimed at reducing car crash related risks which have been related with visual health, functional limitations of physical capabilities and cognitive inabilities. This means that old drivers have higher chance of crashing since they have little insight regarding these challenges (Sullivan, Smith, Lurie-Beck, & Horswill, 2011). It is undeniably known that the rate at which driving-related impairment in people increases with age (O'Connor, Kapust & Hollis, 2008). Therefore, the currently existing licensing policies as stated above do not help old age drivers. For anything, they only preserve the motoring public and safety of drivers. As the system targets old age drivers, its introduction will factor in some measures. For instance, driving competency cannot be measured on age alone. This is true for political as much as for empirical or conceptual reasons. Empirically assessing, the elderly records the lowest per–driver crash rates in Australia. But this statistic is mistimed as there has been no performance feedbacks documented on the same. And this could mean all measures to assess capabilities of old drivers are postponed till old age car crashes escalate. The Current Proposal The establishment of 3-Tier Assessment System will need a comprehensive model to assess its effectiveness and intended ability. To that regard, I propose designing of series of assessment-based evaluative tools that will compare drivers before and after taking the 3-Tier Assessment System. The main objective of the assessment-based evaluative tools will be to necessitate; (a) screening tools that identifies old age drivers in need of further tests and assessments regarding safety of their driving (b) identification of the old age drivers who might benefit from education and training regarding how to safely compensate for identified limitations to driving-relevant functional abilities (c) to determine if the old drivers are too dangerous to take out on road (d) help in assessment of renewal applications of the old people to ascertain whether they have acquired adverse health condition since the original licensure. I propose that this system consist of three levels of testing (tiers) and since it will be done in an operational system, the four mentioned objectives will be met if a driver will be successful in the first tier. In that case, there will be no need for the second and third tier. The driver who will fail the three tiers will not be deemed fit to take on the road. The Form of the Proposed Test The 3-Tier Assessment System has long history. It was first piloted in United States of America by National Highway Traffic Safety Administration (NHTSA) in 2006-2007. In particular, the 3-Tier Assessment System has been growing out of extensive researches conducted. These researches have culminated in a series of recommendations (Hennessy & Janke, 2009; Hennessy & Janke, 2005). These proposals form the proposed test. Nevertheless, these proposals shows that the 3-Tier Assessment System piloted have heard number of limitations based on the current technological trends or specific needs of Australian old drivers working with Australian traffic rules. The limitations identified are; (a) The earlier models presented methodological problems. For instance, when comparison was made between piloting process (administering the 3-Tier Assessment System) and the baseline cohort (the study groups) it was realised that it was not possible to model in such as way that can allow statistical separation driving history of the cohorts from the potential effects of the developed piloting process (Organization for Economic Cooperation and Development, 2001). (b) The 3-Tier Assessment System does not provide evidence of its effect on the reduction of subsequent crashes among the road users. Similarly, the earlier proposed systems did not show evidence on overall effects on the crash risk of old drivers despite it being cognitive oriented test. (c) The systems tested earlier did manage to determine the percentage of old drivers who after being assessed or taking the test and found to have driving limitations were able to regain their driving privileges after successfully undertaking the 3-Tiers. (d) Finally, comparing literatures regarding the 3-Tier Assessment System as proposed before, there is suggestion that there has been inconsistent and weak evidence for its positive effect in reducing the chances of being a victim of a fatal crash or subsequent injury among the old. In the light of these limitations, I therefore propose the establishment of an improved 3-Tier Assessment System that has three tests potentially screening driving complications associated with old drivers. The screen will include cognition and perception, series of test (in the second Tier) to recall memory and comprehensive written renewal test (in the third Tier). The three tiers will run concurrently to determine the level of inter-correlation among outcomes on the 3 Tiers. These will then be stratified according to the age with the lowest and the highest being 50 and 85 respectively. The advantage of the three Tiers the fact that it ensures that old drivers avoid on-the road problems associated with their age and physical frailties (Oulad Daoud & Tashima, 2011). This proposal however, comes with one major limitation. As noted in the 3-Tier Assessment System, it will be difficult to ascertain whether, to a given extent, in what direction, the limitation of the system to indigenous English-speaking Australian may bias or affect other races/ethnicity as the system factors in only black/white race speaking English rather than Hispanic/non-Hispanic groups or white/Asia. Reliability Issues related to the System Basing from the previously tested systems, there have been reliability concerns with the system since it has not been issue based but generalised in the approach (Florida At-Risk Driver Council, 2004). Besides, their reliability has been designed considering traffic rules in a given state within United States. Florida At-Risk Driver Council reports that earlier system was designed in such a manner that in case cohorts age 70+ failed the 1st and 2nd, specifically memory recall test, it was more likely that they will fail written renewal test thus not able to give relationship between old age drivers and future crash risks. My proposal builds on these limitations so as to come up with the 3-Tier Assessment System that incorporates tiered systems of assessment and also include referral for assessment by health care specialist prior to an-on road drive test after completing the 3 Tiers. This will augur well with old drivers owing to the fact that there is already mechanism for assessing potentially unsafe drivers within Australian jurisdiction (Fildes et al., 2008). Validity Hypotheses As noted earlier, this system has one key limitation. That is, the system might not be friendly to non-indigenous English-speaking Australian such as Hispanic/non-Hispanic groups or white/Asia. This also concerns the process of giving tests to non-indigenous English-speaking Australian old drivers taking 3rd Tier test. It therefore means there is a need to succinctly evaluate the validity of the new system (test) in the event the new test might not fit all races within Australia. This is why I propose hypotheses to assess the validity of this test. First, if the test is valid I recommend that the tier include screening test for cognitive and perceptual deficits especially those who are associated with mild cognitive impairment, dementia-type disorder and early-stage Alzheimer’s disease. This will help non-indigenous English-speaking Australian old drivers avoid 3rd tier administered in English. Furthermore, this system will extend the 3TAS to all languages. Proposed Research to Determine Psychometric Properties of the Test To determine the psychometric property of this test the 3-Tier Assessment will consist of series of tiered screening and assessment tools applied to drivers deemed old (covering age bracket of 50-85 years). The screening tools are intended to identify the drivers in need of further testing and assessment of the safety of their driving. The 3 Tier assessments will also identify drivers who will benefit from education identified to curb driving-relevant functional problems. Also part of this assessment will make participants engage in a tiered series of assessment tools by which agency issuing licence will identify referral and renewal drivers in need of further education. Proposed Sample, Design, and Procedure This test will be working with a total of 200 old drivers (n=200). Of the number, 100 hundred will be 50-65 years old drivers with driving experience between 10-30 years (group A). Of the group A, 50% will be renewal old drivers and the other 50% will be old drivers referred from Driver Safety for a drive test. This group will be expected to take drive test in relation to a limited-term license possessed. The other remaining group (100 old drivers, group B) will consist of 66-85 years. They will be expected to take a drive after being affirmed that they have failed on visual acuity standard. After this round, the first group (A) will take test on visual acuity as group (B) take drive test in relation to a limited-term license possessed. This sequence will be adopted in 2nd and 3rd tiers. Crash related incidences from every participant will be established and proper strategies implemented. Possible Outcomes Predicted outcomes of this test are multifaceted. However, this can be narrowed to; (a) Ability to improve visual, cognitive and physical frailties of old drivers. (b) Owing to the limitations of the on-road testing earlier mentioned, it is expected that the test will improve potential traffic safety of Australian old drivers as well as and extending individual mobility. (c) The 3-Tier test is expected to reduce road violations, crashes and erroneous licensing among old drivers who have been deemed unfit on roads. Conclusion As reported earlier, statistically speaking, car related accidents among old drivers in Australia is not as common as other age brackets. However, this age is also faced with cognitive, physical and visual impairment that calls for regular testing. This is what is offered by the 3TAS. In addition to this, 3TAS can be applied in agency or state context and for a wide population of old drivers renewing licences. Furthermore, this test is implementable and workable as currently designed. Nevertheless, if the test has the aforementioned impacts on old drivers remains to be seen in the real life situation. References Cheung, I., & McCartt, A. T. (2011). Declines in fatal crashes of older drivers: Changes in crash risk and survivability. Accident Analysis and Prevention, 43, 666-674. Dobbs, B. M., & Carr, D. (2005). Screening and assessment of medically at-risk drivers. Public Policy and Aging Report, 15, 6-12. Fildes, B., Charlton, J., Pronk, N., Langford, J., Oxley, J., & Koppel, S. (2008). An Australasian model license reassessment procedure for identifying potentially unsafe drivers. Traffic Injury Prevention, 9, 350-359. Fisk, G.D., Novack, T., Mennemeier, M., & Roenker, D. (2002). Useful Field of View after traumatic brain injury. Journal of Head Trauma Rehabilitation, 17, 16-25. Florida At-Risk Driver Council. (2004). The Effects of Aging on Driving Ability. Tallahassee, FL: Department of Highway Safety & Motor Vehicles. Hennessy, D. F., & Janke, M. K. (2009). Clearing a road to being driving fit by better assessing driving wellness: Development of California’s prospective three-tier driving centered assessment system – Technical Report (Report No. 216). Sacramento, CA: California Department of Motor Vehicles. Hennessy, D. F., & Janke, M. K. (2005). Clearing a road to driving fitness by better assessing driving wellness: California’s three-tier driving-centered assessment system – Summary report (Report No. 215). Sacramento, CA: California Department of Motor Vehicles. Horswill, M. S., Anstey, K. J., Hatherly, C. G., & Wood, J. (2010). The crash involvement of older drivers is associated with their hazard perception latencies. Journal of the International Neuropsychological Society, 16(5), 939-944. doi: 10.1017/S135561771000055X Janke, M. K., Masten, S. V., McKenzie, D. M., Gebers, M. A., & Kelsey, S. L. (2003). Teen and Senior Drivers (Report No. 194). Sacramento, CA: California Department of Motor Vehicles. Janke, M., & Eberhard, J. (1998). Assessing medically impaired older drivers in a licensing agency setting. Accident Analysis and Prevention, 30, 347-361. Mazer, B. L., Sofer, S., Korner-Bitensky, N., Gelinas, I., Hanley, J., & Wood-Dauphinee, S. (2003). Effectiveness of a visual attention retraining program on the driving performance of clients with stroke. Archives of Physical Medicine and Rehabilitation, 84, 541-550. Sullivan, K., Smith, S., Lurie-Beck, J. K., & Horswill, M. S. (2011). Are older driver’s perceptions of their driving ability accurately reflected in performance on a driving simulation task? Canberra: NRMA ACT Road Safety Trust. O'Connor, M. G., Kapust, L. R., & Hollis, A. M. (2008). DriveWise: An interdisciplinary hospital-based driving assessment program. Gerontology and Geriatrics Education, 29(4), 351-362. doi: 10.1080/02701960802497894 Organization for Economic Cooperation and Development (OECD). (2001). Aging and transport: Mobility needs and safety issues. Paris: OECD. Oulad Daoud, S., & Tashima, H. (2011). 2011 annual report of the California DUI Management Information System (Report No. 233). Sacramento, CA: California Department of Motor Vehicles. Read More

It is undeniably known that the rate at which driving-related impairment in people increases with age (O'Connor, Kapust & Hollis, 2008). Therefore, the currently existing licensing policies as stated above do not help old age drivers. For anything, they only preserve the motoring public and safety of drivers. As the system targets old age drivers, its introduction will factor in some measures. For instance, driving competency cannot be measured on age alone. This is true for political as much as for empirical or conceptual reasons.

Empirically assessing, the elderly records the lowest per–driver crash rates in Australia. But this statistic is mistimed as there has been no performance feedbacks documented on the same. And this could mean all measures to assess capabilities of old drivers are postponed till old age car crashes escalate. The Current Proposal The establishment of 3-Tier Assessment System will need a comprehensive model to assess its effectiveness and intended ability. To that regard, I propose designing of series of assessment-based evaluative tools that will compare drivers before and after taking the 3-Tier Assessment System.

The main objective of the assessment-based evaluative tools will be to necessitate; (a) screening tools that identifies old age drivers in need of further tests and assessments regarding safety of their driving (b) identification of the old age drivers who might benefit from education and training regarding how to safely compensate for identified limitations to driving-relevant functional abilities (c) to determine if the old drivers are too dangerous to take out on road (d) help in assessment of renewal applications of the old people to ascertain whether they have acquired adverse health condition since the original licensure.

I propose that this system consist of three levels of testing (tiers) and since it will be done in an operational system, the four mentioned objectives will be met if a driver will be successful in the first tier. In that case, there will be no need for the second and third tier. The driver who will fail the three tiers will not be deemed fit to take on the road. The Form of the Proposed Test The 3-Tier Assessment System has long history. It was first piloted in United States of America by National Highway Traffic Safety Administration (NHTSA) in 2006-2007.

In particular, the 3-Tier Assessment System has been growing out of extensive researches conducted. These researches have culminated in a series of recommendations (Hennessy & Janke, 2009; Hennessy & Janke, 2005). These proposals form the proposed test. Nevertheless, these proposals shows that the 3-Tier Assessment System piloted have heard number of limitations based on the current technological trends or specific needs of Australian old drivers working with Australian traffic rules.

The limitations identified are; (a) The earlier models presented methodological problems. For instance, when comparison was made between piloting process (administering the 3-Tier Assessment System) and the baseline cohort (the study groups) it was realised that it was not possible to model in such as way that can allow statistical separation driving history of the cohorts from the potential effects of the developed piloting process (Organization for Economic Cooperation and Development, 2001). (b) The 3-Tier Assessment System does not provide evidence of its effect on the reduction of subsequent crashes among the road users.

Similarly, the earlier proposed systems did not show evidence on overall effects on the crash risk of old drivers despite it being cognitive oriented test. (c) The systems tested earlier did manage to determine the percentage of old drivers who after being assessed or taking the test and found to have driving limitations were able to regain their driving privileges after successfully undertaking the 3-Tiers. (d) Finally, comparing literatures regarding the 3-Tier Assessment System as proposed before, there is suggestion that there has been inconsistent and weak evidence for its positive effect in reducing the chances of being a victim of a fatal crash or subsequent injury among the old.

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