A total of 12 participants applied the tool to the facilities in which they work. Table 1 displays the participants’ characteristics.
Table 1
Participant characteristics
Characteristic | n | % |
Gender | Female | 11 | 92% |
| Male | 1 | 8% |
Profession/Role | Clinician | 3 | 25% |
| Parent | 2 | 17% |
| Government | 2 | 17% |
| Community | 4 | 33% |
| Other | 1 | 8% |
Community Sector | Education | 2 | 17% |
| Health | 3 | 25% |
| Community Organization/Institution | 5 | 42% |
| Public Spaces | 2 | 17% |
Experience working with children with disabilities | Less than 1 year | 1 | 8% |
| 1–3 years | 1 | 8% |
| 4–9 years | 3 | 25% |
| 10–15 years | 1 | 8% |
| 16 + years | 2 | 17% |
| Not applicable | 3 | 25% |
Years working at the current facility | Less than 1 year | 2 | 17% |
| 1–3 years | 1 | 8% |
| 4–9 years | 2 | 17% |
| 10–15 years | 4 | 33% |
| 16 + years | 0 | 0% |
| Not applicable | 2 | 17% |
*Table 1 inserted here*
*Table 2 inserted here*
Table 2
Ratings for feasibility indicators
Feasibility Indicator | n | % |
Length | Much too long | 3 | 25% |
| Long | 8 | 67% |
| Just right | 1 | 8% |
| Short | 0 | 0% |
| Much too short | 0 | 0% |
Difficulty | Very easy | 2 | 17% |
| Easy | 4 | 33% |
| Neutral | 2 | 17% |
| Difficult | 3 | 25% |
| Very difficult | 1 | 8% |
Clarity | Very clear | 4 | 33% |
| Clear | 4 | 33% |
| Neutral | 1 | 8% |
| Somewhat clear | 3 | 25% |
| Unclear | 0 | 0% |
Value | Very valuable | 4 | 33% |
| Valuable | 3 | 25% |
| Moderately valuable | 5 | 42% |
| Slightly valuable | 0 | 0% |
| Not valuable | 0 | 0% |
Length
The mean time it took to complete the CHILD-CHII was 1 hour and 12 minutes (Range = 30 minutes – 3 hours). All but one participant indicated that the length of the tool was ‘Long’ (67%) or ‘Much too long’ (25%) (Table 2). The one participant who thought the length was ‘just right’, indicated that they were able to answer the items based on knowledge of the facility and assumptions. They were not able to physically go into the facility to assess due to the SARS-CoV-2 (COVID-19) pandemic. They did mention that if they were to go and retrieve specific information on the items, it may have taken longer.
The length was predominantly linked to the scope of the tool with its three assessments, being perceived as too much of a time commitment by the participants. The fact that parts of the tool require information from other sources like coordinators, managers, and potentially community representatives in addition to web searches, made the assessment take a long time to complete, given the need to find the appropriate sources who would have the information. Hence, the items that the participants were able to respond to by themselves did not take too long but the items that required information from other sources took much longer to obtain. Participants stated that highlighting the type of information that may be required and having examples of the people who may have that information, at the beginning of each assessment, would facilitate the process. Furthermore, making it clear that some parts may be skipped if not related nor applicable to the facility, would also reduce the time taken to complete the index.
Participants suggested that the order of the items should be rearranged in a logical sequence to reduce the time. For example, it was mentioned that having items that require the physical evaluation of spaces that are close to one another should be placed subsequently. As well as items or sections that address specific areas of a facility should be grouped and placed sequentially (e.g. items related to the parking lot leading to items addressing the entrance to the facility, then to features of the door).
Difficulty
The ratings for the difficulty of gathering the required information to complete the tool were quite heterogenous (Table 2). Based on the comments by the participants, the difficulty level was dependent on the evaluator’s familiarity with the concepts brought forth in the tool. Participants who were already working in the field of accessibility for their institution found the items easier to obtain information for completion. Additionally, participants in the coordinator or managerial positions as well as government staff were able to respond to items addressing the ‘Programs/Services’, ‘Staff’, and ‘Policies’ inclusion domains without difficulty. In contrast, clinicians and participants working more directly with children with disabilities found those items more difficult to gather information on and respond. However, participants working directly with children with disabilities found it easier compared to coordinators, managers, and government staff to respond to items related to the ‘Built Environment’ and ‘Equipment’ inclusion domains.
Clinicians and community organization staff reported that it was easier to respond to the On-Site assessment, as they were well aware of their specific institution. Participants generally found the Organizational and Macro Community-At-Large assessments more difficult to complete as they did not have access to the information and simply did not possess the knowledge related to the Programs/Services’, ‘Staff’, and ‘Policies’ inclusion domains; identifying the proper people who have access to the information required to respond to the items in these assessments were reported to be difficult. Subsequently, finding the information to respond to these questions were also reported to be difficult.
Parent participants completed the tool based on their knowledge of the institution and did not apply the tool physically at the site due to the ongoing COVID19 pandemic. Hence, based on this fact, they reported that the completion of the tool was not difficult, but they did foresee its difficulty if and when they would need to apply it on-site.
Both clinician and parent participants mentioned that it was and would be difficult to go further beyond their self and close colleagues to obtain the required information. For clinicians, due to the large patient caseload and paperwork already part of their daily work, it was difficult to take the time to obtain all the required information. For parents, they stated that it would be difficult to reach out to other people and research the information while caring for their child with disabilities and other life tasks.
Having the option to complete the tool on the online platform was mentioned to be useful and participants stated that an online version of the CHILD-CHII should be further refined and used in future versions.
Clarity
Eight participants (66%) indicated that the items in the tool were ‘Clear’ (33%) or ‘Very clear’ (33%) in what they were asking. Participants reported that access to the glossary was helpful in clarifying some of the terminology (Table 2). One participant who rated the items as ‘Somewhat clear’ stated that they did not know of the glossary initially and referred to the glossary afterward and mentioned that the glossary did make it clearer. The need for the existence of the glossary to be highlighted in the manual and the tool itself was reported.
It was also mentioned that the purpose and objectives of each assessment type (ie. On-Site, Organizational, Macro Community-At-Large) should be clearly stated and defined at the beginning of each section, which will inform and help clarify what the evaluator will be doing and achieving in the particular section.
Participants also found items addressing specific rooms and places of a facility to be unclear in terms of which rooms and places should be considered when responding to the items. For example, for facilities with multiple bathrooms, it was unclear which one should be chosen to answer the items in the ‘Bathroom’ section. They were unsure if they had to respond for all the bathrooms in the facility or a single one. In most cases, the multiple bathrooms had different levels of inclusive features.
Value
Seven participants (58%) rated the information gathered by the tool to be ‘Valuable’ (25%) or ‘Very valuable’ (33%) (Table 2). These participants reported that the tool is valuable for facilities that are looking to make changes in their accessibility and inclusion and gives a good understanding of the current state of the facility and what is in and around it. Participants valued the items and how they built upon one another while addressing the overarching concept of inclusion. One participant mentioned that it was “thought-provoking” and led to reflections on their “own interventions and practices”. The tool itself brought to light some aspects of the facility that were important for inclusion of children with disabilities, but they were not aware of, which they appreciated. A participant from the government sector mentioned that the tool could be a common platform that connects the different departments within the municipal government- the building department, engineering department, and inclusion department- the assessment would be “helpful to bring everyone together”. Participants also reported that the CHILD-CHII shed light on areas of the facility that they did not previously think about with regards to inclusion of children with disabilities (e.g. Public transportation routes and accessible signage for getting around inside the facility).
Five participants (42%) rated the information to be ‘Moderately valuable’ (Table 2). These participants were involved in the accessibility/inclusion sphere of their corresponding institutions and stated that they were already aware of most of the things outlined by the tool- “being in the field, [participant] already know the thing that need to be changed”, “tool was not necessarily needed to know what to change”. For community organizations that are solely focused on accessibility and inclusion, “accessibility and inclusion are already considered” and the facility was built with accessibility and inclusion in mind. However, these participants did state that the tool and the information gathered by the tool would be valuable and helpful to facilities that are not involved in the field and would require support in establishing accessibility and inclusion.
One interesting theme brought forth by the participants was in regard to the possibility of change and their capacity to make a change. They found that some aspects of the assessment, especially the inclusion domains related to ‘Programs’, ‘Staff’, and ‘Policies’ is “too removed from what [they] can do” and “directly impact”. This theme was more prominent among clinicians and community organization staff who worked more closely on the ground. Some of the aspects of the tool are “beyond the possibility of the institution” or the individual and could be discouraging for the evaluator as some evaluators “do not have the power to make a change”. If the evaluator does not see that they are able to make a change within a certain domain, they may not find “value or worth for the evaluator”; some “would not be able to do anything with the information”. However, participants did find that the results of the tool “can be brought to a higher manager to target and address the gaps that were found” and saw that it can be used to advocate for change and as resource supports, perhaps with several other facilities within a municipality or region.
Clinician and parent participants stated that having more opportunities to expand on certain responses to items, in the form of a comment section, would make the tool more valuable. Parents also mentioned that having access to the scores of the facilities in their local community would be valuable to access for their consideration.
Parents highlighted the value of being more specific in addressing the aspects of the facility while the other participant groups found that being too lengthy for their scope of practice could be of less value. Most participants mentioned that the perceived value of the tool and the information gathered would influence the time and effort put into completing the tool.