FINAL REPORT DISCIPLINE OF OCCUPATIONAL THERAPY

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1 FINAL REPORT QUEENSLAND REGIONAL TRAINING NETWORK HEALTH DISCIPLINE GROUPS 2014 DISCIPLINE OF OCCUPATIONAL THERAPY A collaboration between The Queensland Occupational Therapy Fieldwork Collaborative (QOTFC), the University Occupational Therapy Practice Education Network Queensland (UOTPENQ) and the Mental Health Occupational Therapy Reference Group (MHOTRG) Name of Project Lead: UOTPENQ

2 TABLE OF CONTENTS TABLE OF CONTENTS EXECUTIVE SUMMARY Introduction Outcomes achieved Recommendations PROJECT OVERVIEW Purpose Background OBJECTIVES AND OUTCOMES Practice Educator Needs Analysis Workshops RECOMMENDATIONS REFERENCES APPENDICES Survey respondent list Budget / Financial Report Focus Group Agenda Survey Questions...15 Page 2 of 18

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4 1.0 EXECUTIVE SUMMARY 1.1 Introduction The Queensland Occupational Therapy Fieldwork Collaborative (QOTFC) was formed in 2004 and comprises occupational therapy representatives from key stakeholders in practice education, Queensland universities providing occupational therapy training, occupational therapy professional bodies, major employers and clinicians. QOTFC was developed to provide strategic direction and leadership across Queensland to establish collaborative relationships across all stakeholders and support growth of high quality practice education opportunities. The University Occupational Therapy Practice Education Network Queensland (UOTPENQ) was formed in 2009 with four (4) member universities: University of Queensland (UQ), James Cook University (JCU), University of the Sunshine Coast (USC) and Southern Cross University (SCU) with initial financial support from the QOTFC. UOTPENQ aims to provide a coordinated, collaborative and innovative approach to the growth, development and sustainability of quality practice placements within Queensland. Through its work, UOTPENQ has contributed to capacity development through consideration of statewide placement distribution and equity and provision of strategic direction around placement requirements and needs. Since its formation, UOTPENQ s membership has grown to include seven (7) universities, with the emergence of three (3) new occupational therapy programs (Central Queensland University (CQU), Griffith University (GU) and Australian Catholic University (ACU)) since is a year of transition for QOTFC and UOTPENQ with the introduction of new universities providing undergraduate occupational therapy programs in Queensland, the increasing number of pre- entry students, a significant increase in placement demand and the broadening scope of occupational therapy practice influencing employment prospects for graduates. It is essential that both groups move forward with a clear understanding of stakeholder needs, and a strong, shared vision of the roles and responsibilities of each group in meeting these needs. The groups sought QRTN funding to enable the undertaking of a project to identify stakeholder needs, and to utilise the outcomes to establish a shared future direction for the two groups. The project activities would include a series of focus groups (aimed at identifying regional and rural- specific needs), a state- wide survey; and facilitated workshops for QOTFC and UOTPENQ. Additionally, the project group were asked by the QRTN review panel to specifically consider the needs of the OT mental health workforce and these were addressed through the addition of a Mental Health Occupational Therapy Reference Group (MHOTRG) member on the project steering group, targeted focus groups and survey questions The MHOTRG provides leadership and advocacy for the Occupational Therapy workforce, and is an expert reference group which provides strategic advice and information to both the Queensland Health Mental Health Alcohol and Other Drugs Branch and to the Queensland Health Allied Health Professionals Office of QLD. MHOTRG aims to identify areas for growth in mental placement capacity with particular focus on private, NGO sectors. Page 4 of 18

5 1.2 Outcomes achieved Focus group data and responses from the survey were collated and analysed. This enabled identification of key topics which will inform the actions of the groups. Workshops held between both groups were successful in providing clarity around roles, responsibilities and discussion resulted in the development of a twelve month action plan which has been developed in response to key issues. Following consideration of the results of this project, broad recommendations will inform the groups priorities over the next 12 months. 1.3 Recommendations 1. Collaboration: UOTPENQ and QOTFC to lead the formation of collaborative processes that will: a. Promote a comprehensive, integrated approach from both groups to both the strategic development and operational implementation of practice education across the state b. Strengthen relationships with organisations, line managers and practice educators/potential practice educators to address key issues affecting practice education, at both the strategic and operational levels c. Promote linking of state and national agendas for practice education 2. Visibility and communication: UOTPENQ and QOTFC to develop initiatives and processes that will: a. Increase awareness of the professional community, employers and other stakeholders regarding the roles of these groups b. Provide a range of avenues for information provision, discussion and problem solving that meet the needs of all stakeholders 3. Leadership and capacity building: UOTPENQ and QOTFC to develop and communicate a clear position on practice education growth and quality in the state, together with a plan for capacity building and support of practice educators. This will include: a. Development of a position statement on paid placements. b. Promoting critical evaluation and ongoing investigation of innovative solutions c. Engaging the professional community in knowledge translation from existing practice education evidence and communicating the critical success factors for alternative placement models d. Evaluating and lobbying for the most effective use of resources for supporting practice educators, generating placement numbers and promoting quality practice education. 4. UOTPENQ and QOTFC to explore options for funding to support centralised processes to address these recommendations and strategic priorities 5. UOTPENQ and QOTFC to commit to reconvene together mid and end of 2015 to evaluate and report on progress Page 5 of 18

6 2.0 PROJECT OVERVIEW 2.1. Purpose Health Workforce Australia has funded a Queensland Regional Training Network project to address issues and solutions to the looming need for increased numbers of clinical placements for occupational therapy (OT) students. The project is intended to broaden and strengthen industry- education links and identify barriers and enablers to growth and development of pre- entry clinical education (also known as practice education) opportunities in Queensland. The Queensland Occupational Therapy Fieldwork Collaborative (QOTFC) jointly with The University Occupational Therapy Practice Education Network Queensland (UOTPENQ) succeeded in obtaining a grant to undertake this project. A representative from the Mental Health Occupational Therapy Reference Group (MHOTRG) was added to the project group at the request of the QRTN Review Panel to ensure the needs of the mental health occupational therapy workforce were specifically identified Background As of 2014 there are seven universities in Queensland providing OT programs in Queensland: in the South- East there are the University of Queensland (UQ), Griffith University (GU), the Australian Catholic University (ACU) in Brisbane, Southern Cross University (SCU) on the Gold Coast and the University of the Sunshine Coast (USC) at Sippy Downs; in Central Queensland there is the Central Queensland University (CQU) at Rockhampton; while Far- North Queensland has James Cook University (JCU) at Townsville. This means that in Queensland, there will be about OT students graduating annually, each of whom must have had 1000 hours of clinical contact during their training in order to meet World Federation of Occupational Therapists standards (World Federation of Occupational Therapists, 2002) and those of Australia s Occupational Therapy Council (Occupational Therapy Council, 2013). This project aims to anticipate that situation and to explore the barriers and solutions to the increased need for clinical placements. In particular, the project has been tasked with seeking increased clinical opportunities with Queensland Clinical Education and Training Council (QCETC) priority areas including: Aged care Indigenous health Mental health Private sector, and Rural and Remote The Queensland Occupational Therapy Fieldwork Collaborative (QOTFC) was formed in 2004 and comprises OT representatives from key stakeholders in practice education, Queensland universities providing OT training, OT professional bodies, major employers and clinicians. QOTFC was developed to provide strategic direction and leadership across Queensland, to establish collaborative relationships across all stakeholders and to support growth of high quality practice education opportunities. In 2014, QOTFC has begun a period of transition with membership changes and early stages of a process of re- evaluation. Page 6 of 18

7 The University Occupational Therapy Practice Education Network Queensland (UOTPENQ) was formed in 2009 with four member universities: University of Queensland (UQ), James Cook University (JCU), University of the Sunshine Coast (USC) and Southern Cross University (SCU) with initial financial support from the QOTFC. UOTPENQ aims to provide a coordinated, collaborative and innovative approach to the growth, development and sustainability of quality practice placements within Queensland. Through its work, UOTPENQ has contributed to capacity development through consideration of state- wide placement distribution and equity and provision of strategic direction around placement requirements and needs. Since its formation, UOTPENQ s membership has grown to now include seven universities, with the emergence of three new OT programs (Central Queensland University (CQU), Griffith University (GU) and Australian Catholic University (ACU) since UOTPENQ meets twice yearly to deal with practice placement requests and allocation for students from all seven Queensland universities offering OT programs. The Mental Health Occupational Therapy Reference Group (MHOTRG) provides leadership and advocacy for the Occupational Therapy workforce, and is an expert reference group which provides strategic advice and information to both the Queensland Health Mental Health Alcohol and Other Drugs Branch and to the Queensland Health Allied Health Professionals Office of QLD. MHOTRG aims to identify areas for growth in mental placement capacity with particular focus on private, NGO sectors. The project was undertaken in two stages: i. Practice Educator Needs Analysis comprising of statewide surveys and focus groups to identify the needs and opinions of Queensland Occupational Therapists regarding practice education, and the roles and responsibilities of QOTFC and UOTPENQ. ii. UOTPENQ and QOTFC facilitated workshops aimed to analyse the results of the needs analysis, consider the current working model for each group, consider the relationship between the two groups, and integrate outcomes of these discussions into a twelve month action plan for both groups. Page 7 of 18

8 3.0 OBJECTIVES AND OUTCOMES 3.1 Practice Educator Needs Analysis Objectives To engage and collaborate with existing and potential placement providers across Queensland, and ensuring inclusion of QCETC priority areas To identify needs of placement providers for increasing capacity and gather their input around potential solutions and strategic priorities relating to practice education from their perspective and from the perspective of the profession as a whole To make recommendations to stakeholder groups regarding clinical education capacity in OT in Queensland The above aims will include identification of needs and opportunities specific to the mental health sector. In order to move from Objectives to Outcomes, it was necessary to engage with occupational therapists to discern their views of the current barriers or factors affecting the creation and maintenance of sustainable practice placements. This was completed through the use of focus groups and survey Methodology A Project Officer was appointed in September 2014 to carry out focus groups and a widely- disseminated on- line survey to ascertain, as far as possible, the opinions and experience of OT clinicians practicing in Queensland regarding the offer, uptake and support of clinical placements. Tools i. Hour- long face- to- face focus groups were held in Toowoomba, Townsville and at the Occupational Therapy Association (OTAL)(Queensland) conference at Noosa. Video- conferences were also held within Queensland Health with both Clinical Education Support Officers (CESOs) from throughout Queensland and with Queensland Health mental health practitioners. ii. A thirty- three question SurveyMonkey survey was distributed widely using the Occupational Therapy Australia Ltd (OTAL) Queensland database as well as networks and contacts of QHealth Clinical Education Support Officers (CESOs), and UOTPENQ, and QOTFC members. This was completed by 322 participants from across Queensland. Page 8 of 18

9 Participants Table 1 demonstrates the most frequently cited areas of practice: Area of Practice % 30.0 % 25.0 % 20.0 % 15.0 % 10.0 % % % % aged care paediatrics indigenous health mental health vocational rehabilitation private sector rural and remote hospita communit l y othe r Table 1: Area of Practice of Survey Respondents Table 2 demonstrates the position within the organisation as described by the respondent. Manager includes such positions as Team Leader, Director of OT services, Regional Manager, Manager of Allied Health. Private Practice Manager includes those respondents who identified as both an OT and a director/ceo of a private practice. Clinical Education refers to those positions where the OT is employed to coordinate and develop student placements, or oversee this e.g. Qld Hospital and Health Service Clinical Education Support Officers, and the State- wide Clinical Education Leader positions. Senior clinician includes those therapists who identified either a senior or advanced clinical position, and clinician refers to those who identified a base grade position or did not specific their level % % % 40.0 % 30.0 % 20.0 % 10.0% % 0.0 % Manage r Private practice manager Clinical Education Universit y Position within organisation clinicia n Senior clinician Table 2: Survey Respondents identified position within their organisation Page 9 of 18

10 Table 3 demonstrates the broad spread of geographical location of work- place for survey respondents. For a listing of Post Codes of both survey respondents and focus group participants, see attached. (Appendix 6.1). Table 3. Location of Work- Place of Survey Respondents Outcomes The focus group data and responses from the survey were collated and analysed. Feedback was categorised into the following topics: Models of supervision Apprenticeship (one therapist to one student) and Shared (two or more therapists in one workplace with one student) models were most common Alternative models far less frequently used e.g. collaborative, student- assisted, multiple mentoring, role emerging Therapist workload Many positives about the student supervision process Significant concerns primarily regarding time and workload constraints Additional burdens of supervising a student experiencing difficulties Availability of suitable accommodation for students in rural and remote locations Lack of availability and expense continues to be a considerable barrier. Training of Practice Educators Number of therapists who had undertaken training was positive Workload demands and availability of training in some rural areas were a limiting factor in accessing training. Page 10 of 18

11 Local student coordination Qld Health participants cited the value of CESOs in organising, supporting and trouble- shooting practice placements Outside Qld Health, 37% of therapists described a lack of process for coordinating and managing student placements and issues in their work- place, region or interest group Support from universities High percentage rated the support from universities as sufficient or better than sufficient but indicated that further support would assist capacity building Challenges created by students requiring more support during placements due to performance issues Therapists continue to appreciate a quick response from the universities when requested for students experiencing difficulties. Organisational issues at universities Sufficient flexibility of the universities to suit the placement dates Diversity of comments regarding advantages and disadvantages of different length block placements Professional / university issues Concerns regarding growth of university occupational therapy programs, and the current and future workforce capacity Concerns regarding standards of clinical competence due to decreased university entry scores, perceived pressure to pass students Need for clear expectations regarding aims of clinical placements Rural and remote placements identified as an opportunity for growth; but balanced by capacity for students to undertake rural/regional placements (due to lack of/limited opportunities for funding, accommodation) Workplace organisation Currently high numbers of part- time staff, and staff on contract which influences ability to predict availability to offer placements Culture around support from management and colleagues for practice education varies across regions and organisations Organisational policies and procedures impact on students ability to complete tasks independently (i.e. without direct supervision) e.g. driving Other ongoing issues include shortage of computer, desk and treatment space for students. UOTPENQ Limited understanding of UOTPENQ allocation processes and how the collaborative process enhances student allocation. Page 11 of 18

12 QOTFC A third of participants were unaware of QOTFC and their role A third of participants had accessed the online training site Clinical Educator s Resource Kit Incentives Many respondents suggested that incentives for providing student placements may lead to increased offers; these suggestions varied in number and type Incentives suggested included payment, university provided supervision, CPD points, university access benefits e.g. library access Mental Health specific issues Presence of other medical, nursing and allied health students within local teams Risks posed by more complex clients and caseloads Impact of organisational policies on student participation e.g. no driving Understanding of OT role in case management Student interest and preparation for mental health specific placements Preference for apprenticeship model 3.2 Workshops Objectives To review roles, lines of communication and processes around placement establishment, management and sustainability. To redesign processes in response to findings. To develop recommendations to stakeholder groups regarding clinical education capacity in OT in Queensland. To identify needs and opportunities specific to practice education in the mental health sector Methodology Members of UOTPENQ, QOTFC and MHOTRG were invited to participate in a two- day facilitated workshop held at The University of Queensland. The agenda for the workshop enabled collaborative discussion across the groups as well as time to independently discuss and resolve issues specific to each network. Discussions were informed by survey results, focus group responses, current research in practice education and the professional experience and expertise of participants. The final session facilitated collaborative action planning between UOTPENQ and QOTFC to develop strategic priorities and action plans for both groups over the next 12 months. Page 12 of 18

13 3.2.3 Outcomes A two- day facilitated workshop was conducted with representatives from UOTPENQ and QOTFC. Members from MHOTRG were unable to attend; however, their viewpoints were captured in survey and focus group results and discussed throughout the two days. A meeting will be arranged with MHOTRG when key representatives return from leave to discuss recommendations and action from here. Four broad categories of stakeholder need emerged from discussions. The broad categories and UOTPENQ/QOTFC responses to these needs are identified below. It should be noted that UOTPENQ and QOTFC have capacity to respond directly to identified items 1 and 2; however items 3 and 4 refer to workforce needs and responses need to be enacted largely through the development of industry relationships. A twelve month action plan has been developed in response to key issues. 1. To increase the visibility of UOTPENQ and QOTFC within the OT community. Identified response: a. Promote an awareness of the roles and processes of the groups in practice education b. Highlight current efforts and strategies to address placement shortages within Queensland c. Disseminate results of project d. Showcase innovations and success stories within practice education e. Facilitate wider distribution of resources and supports already available to practice educators 2. To further develop and consolidate state- wide processes within UOTPENQ and QOTFC. Identified response: a. Build capacity in practice education across Queensland through targeted recruitment and mentoring processes b. Ensure high quality, sustainable placements into the future through collaborative partnerships with key stakeholders c. Provide increased university support to practice educators d. Streamline current practices to promote efficiency and flexibility through centralised processes 3. To acknowledge and respond to workload issues as a barrier to building capacity in practice education. Identified response: a. Lead change in the area of practice education through evidence based practice, knowledge translation, expanded support, showcase success stories, promote professional responsibilities and facilitate ownership of developing our future profession b. Develop a position statement on payment for placement c. Develop alternatives and incentives to support practice educators Page 13 of 18

14 4. To acknowledge and respond to organisational and workforce issues as a barrier to sustainable professional practice placements in the future. Identified response: a. Lobby executives and directors within organisations to promote the value of practice education within the OT community and workplace b. Lead change in the area of practice education c. Discuss and problem solve the impact of workplace policies on practice education, particularly in the area of mental health d. Provide flexibility and support to workplaces through alternative placement options and more effective state- wide processes. 4.0 RECOMMENDATIONS Following consideration of the results of this project, these broad recommendations will inform the groups priorities over the next 12 months: 1. Collaboration: UOTPENQ and QOTFC to lead the formation of collaborative processes that will: a. Promote a comprehensive, integrated approach from both groups to both the strategic development and operational implementation of practice education across the state b. Strengthen relationships with organisations, line managers and practice educators/potential practice educators to address key issues affecting practice education, at both the strategic and operational levels c. Promote linking of state and national agendas for practice education 2. Visibility and communication: UOTPENQ and QOTFC to develop initiatives and processes that will: a. Increase awareness of the professional community, employers and other stakeholders regarding the roles of these groups b. Provide a range of avenues for information provision, discussion and problem solving that meet the needs of all stakeholders 3. Leadership and capacity building: UOTPENQ and QOTFC to develop and communicate a clear position on practice education growth and quality in the state, together with a plan for capacity building and support of practice educators. This will include: a. Development of a position statement on paid placements. b. Promoting critical evaluation and ongoing investigation of innovative solutions c. Engaging the professional community in knowledge translation from existing practice education evidence and communicating the critical success factors for alternative placement models d. Evaluating and lobbying for the most effective use of resources for supporting practice educators, generating placement numbers and promoting quality practice education. 4. UOTPENQ and QOTFC to explore options for funding to support centralised processes to address these recommendations and strategic priorities 5. UOTPENQ and QOTFC to commit to reconvene together mid and end of 2015 to evaluate and report on progress Page 14 of 18

15 5.0 REFERENCES Moores, A. (2014). Occupational Therapy Clinical Education Program: Summary of student placements Sep Brisbane: Queensland Health. Occupational Therapy Council. (2013). Occupational Therapy Accreditation Standards. South Perth, WA: OTC. Access at World Federation of Occupational Therapists. (2002). Revised minimum standards for the education of occupational therapists. Forrestfield, WA: WFOT. 6.0 APPENDICES 6.1 Survey respondent list See attached electronic file for list of 358 respondents. Names have been removed due to privacy considerations. 6.2 Budget / Financial Report To be prepared and forwarded by OTAL 6.3 Focus Group Agenda 6.4 Survey Questions Page 15 of 18

16 Appendix 6.4 FOCUS GROUP AGENDA Background: Health Workforce Australia has funded a Queensland Regional Training Network project to address issues and solutions to the looming need for increased numbers of clinical placements for Occupational Therapy students. In the next year or so, there will be seven OT schools in Queensland seeking clinical placements for their students. In particular, the project has been tasked with seeking increased clinical opportunities with Queensland Clinical Education and Training Council priority areas including: Aged care Indigenous health Mental health Private sector, and Rural and Remote. Project: As part of this project, Linda Cartmill will be conducting several Focus Groups and using surveys during September and October 2014 to solicit the views of as many occupational therapists as possible regarding the offer, uptake and support of clinical placements. Separate and combined facilitated workshops will be held with the UOTPENQ group and the QOTFC group. These workshops will investigate their roles and modes of operating and consider both the feedback coming from occupational therapists in the field, and the constraints within which their organisations must function. Project Outcomes: A Final Report will be developed which will include recommendations to address clinical education capacity issues for Occupational Therapy in Queensland as well as strategies to address current and anticipated issues. Agenda Items for discussion: 1. Obstacles to taking students 2. Organisational issues re allocating students from particular Universities 3. Possible solutions at local and State- wide levels 4. Models of student supervision 5. Preferred models of support from Universities 6. How are the various training opportunities for Clinical Educators working? 7. In your group/region/special interest group is there a structure for coordinating issues relating to student placements? 8. Is it working well? 9. How could it improve? 10. Other Page 16 of 18

17 Appendix 6.5 SURVEY QUESTIONS SURVEYMONKEY SURVEY CREATING SUFFICIENT OCCUPATIONAL THERAPY CLINICAL PLACEMENTS Q1. What is your name (voluntary)? Q2. What organisation do you work for? Q3. What is your position? Q4. What is the post code of your workplace? Q5. What is your area of practice? (You may choose several areas.) Q6. Where do you work? Q7. Have you supervised an OT student before? Q8. Rate your overall experience of supervising OT student/s Q9. What model/s of supervision have you used? (Select as many as relevant) Q10. What were the positives for you about the experience? (Select as many as relevant) Q11. What were the negatives for you about the experience? (Select as many as relevant) Q12. I would take a student in the future. Q13. As a therapist, what are some of the barriers/difficulties in taking a student? (Select as many as relevant) Q14. From a student's point of view what might be the difficulties/barriers to undertaking a placement in your locality/speciality? (Select as many as relevant) Q15. Can you suggest potential solutions at local and State- wide levels to the difficulties in securing sufficient numbers of practice placements? Describe. Q16. Current strategies you are using. Q17. With regards training opportunities for Practice Educators, what do you have access to in your area? Q18. Have you undertaken training as Practice Educator? Q19. If you have accessed training, what format was it and was it useful? Q20. In your workplace/region/special interest group is there a process for coordinating and managing placements and issues relating to placements? Q21. Please rate the university support you receive as to how Well it enables you to successfully maintain practice placements. Q22. With regards the length of placements requested by universities, please comment on how it impacts the ability of your facility to offer student placements. Q23. With regards the timing of university placements, please comment on how it impacts the ability of your facility to offer student placements. Q24. Please rate how well you feel the current twice yearly allocation of requests for student placements suits you. Q25. Please rate how well UOTPENQ communicates/collaborates re requests and allocation of placements. Q26. How satisfied are you that UOTPENQ makes a positive contribution to student placement request and allocation processes? Q27. QOTFC developed Clinical Educators Web- site. Have you used this site? Page 17 of 18

18 Q28. Please rate the usefulness of the Clinical Educator's Resource Kit. Q29. How satisfied are you that QOTPEC makes a positive contribution in furthering fieldwork opportunities and experiences in Queensland? Q30. Please comment on what role you would like QOTPEC to take in the future. Q31. Can you suggest possible student placement opportunities in your workplace/region/specialty interest area (particularly in aged care, indigenous health, mental health, private sector, rural and remote)? Q32. Can you suggest any other potential placement options? These might include organisations apart from your own which you feel could respond positively to an approach from a University. Q33. Do you have any final comments/feedback regarding the request and allocation of student placements in Queensland? Page 18 of 18

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