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)

In response to concerns that older driver-license-renewal applicants who have significant sensory and motor deficits would nonetheless be able pass a licensing road test, the California Department of Motor Vehicles (DMV) conducted a multi-year study of driving from an ecological perspective. In an ecological perspective, drivers are viewed as actively adjusting the demands of their driving environments and the demands of their driving tasks in accordance with their perception of their driving-relevant abilities and limitations. We confirmed this and other ecology-driven predictions with our study of California's prospective three-tier driving-centered assessment system. Driving-centered is an ecological concept—it means taking into consideration when, where, why, and how individual drivers customarily drive. The traditional approach to assessment, taken by most DMVs, is driver-centered. Traditional assessment is focused on the accurate identification of high-risk drivers. It is an endpoint in the controlling and delicensing of these problem drivers. Traditional assessment does not take into consideration when, where, why, and how individual drivers customarily drive. The driving-centered Three-Tier Assessment System (3-Tier) described in this study report represents fundamental changes in the approach and objectives of driver assessment. "3-Tier" is offered as the answer to the following fundamental question posed at the beginning of the study: How can the DMV better identify and assess licensed drivers of any age who have acquired a driving-relevant functional limitation(s) so that the DMV, together with physicians, driving-rehabilitation specialists, and others can aid such drivers, if feasible, in driving safely by referring for physician-based evaluation and treatment, educating about driving-relevant limitation(s), recommending behind-the-wheel training, restricting (conditional licensure), and so on? Rather than an endpoint, 3-Tier fundamentally alters the purpose of assessment to be a starting point in extending the safe driving years of functionally-limited licensed drivers. California's prospective three-tier driving-centered assessment system serves as the starting point for initiating various means of extending the safe-driving years of functionally-limited licensed drivers. By extending their safe-driving years, 3-Tier aids functionally-limited drivers in maintaining their safe mobility which is viewed as a resource for everyday healthy living in our aging driving population. This report has two main purposes: (1) describe the development of California’s prospective 3-Tier driving-centered assessment system, and (2) present an "ecological perspective" on driver licensing. Driving-centered is an ecological concept—it means taking into consideration when, where, why, and how individual drivers customarily drive. Rather than an endpoint in delicensing drivers assessed as unsafe, 3-Tier fundamentally alters the purpose of assessment to be a starting point, if feasible, for extending the safe driving years of functionally-limited licensed drivers. The 3-Tier system integrates new assessment tools into those currently used by the Department of Motor Vehicles. All renewal applicants required to pass the department’s knowledge test are assessed on Tier 1, and those who are found to have a driving-relevant visual, mental, or physical limitation(s) are further screened on Tier 2. Based on these assessments, drivers are classified as driving well, somewhat functionally limited or extremely functionally limited; the extremely functionally-limited drivers are required to pass a Tier 3 road test to be licensed. The results of a small scale pilot study upon which the 3-Tier system was developed showed that somewhat-limited drivers, perhaps because they were less aware of their limitations, were more likely to be crash involved than extremely-limited drivers, who were probably more aware of their limitation(s) and compensated accordingly. In contrast, extremely-limited drivers were more likely to fail an office-based road test. The report concludes with 22 recommendations for statewide implementation of 3-Tier, including recommendations that the department’s R&D branch evaluate the reliability and validity of the current area drive test, and if needed, develop a better one, that this test be available to extremely limited drivers as an option for their Tier 3 road test requirement, and that the department educate somewhat-limited drivers about compensating for their limitation(s). Language: en This report is available online at: http://www.dmv. ca.gov/about/profile/rd/r_d_report/Section%202/sec_II_216. pdf