EDUCATIONAL /QUALIFICATIONS OF PHYSICAL THERAPISTS IN

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1 EDUCATIONAL /QUALIFICATIONS OF PHYSICAL THERAPISTS IN PUBLIC HEALTH AGENCIES 1. General Scope of the Field DHYSICAL therapy is an integral part of health and medical care programs. It plays a vital role in the maintenance of health of the individual and the community. Physical therapists, through their professional activities, contribute to the prevention and correction of human disabilities or potentially handicapping conditions. In public health, physical therapists perform duties which include planning, organizing, evaluating, interpreting, coordinating, and supervising physical therapy; consulting and advising other professional workers and organizations; participating in the development and conduct of community health studies; teaching individuals and groups; and 322 rendering direct care to patients. These activities are carried out in continuous association with the administering agency and with allied organizations. Physical therapy in public health began in 1915 when the first physical therapist was employed by the Vermont State Health Department to administer treatments to poliomyelitis patients in their homes. During the period from 1920 to 1946, a limited number of physical therapists was employed for home care in nonofficial agencies, such as Visiting Nurse Associations, local affiliates of the National Society for Crippled Children and Adults, the National Foundation for Infantile Paralysis (National Foundation), and in official State Crippled Children's agencies. The demand for physical therapists by health agencies has grown with increasing rapidity and far exceeds the supply of qualified personnel. It is estimated that a growing number of practicing physical therapists are employed in public health agencies, exclusive of positions in hospitals, clinics, and other institutions under public or private auspices. Since 1936, some of the factors which have influenced this growth are: 1. Rapid advances in medical knowledge and in the use of physical therapy in prevention and treatment of an ever increasing variety of conditions; 2. Increased knowledge of the problems of the chronically ill and the mentally and physically handicapped has resulted in a rapid expansion of programs of medical care, including rehabilitation for all age groups; 3. Expansion of programs of local and state health departments because of federal funds made available through such legislation as Social Security and Community Health Services and Facilities Acts; 4. Increased awareness that the care of the chronically ill requires a comprehensive interdisciplinary approach which takes into account the psychological, social, educational, and vocational aspects of the patient's status as well as his medical condition; 5. Educational programs which have resulted in greater demand for advisory, consultative, and instructional services by physical therapists. In out-of-hospital health care programs, under both public and voluntary auspices, physical therapists serve as consultants and advisers to administrators of hospitals, nursing homes, rehabilitation centers, schools, other institutions, and related professional programs and personnel. They serve as di- VOL. 56, NO. 2, A.J.P.H.

2 QUALIFICATIONS OF PHYSICAL THERAPISTS rectors of physical therapy services on a state-wide basis, or supervisors in a local area. In staff positions, they render direct service to patients and instruct families and others in adaptive equipment and procedures to be carried out in the patients' homes or substitute homes. Accurate information as to the number of these positions is not available. The largest number is on the staffs of official state, county, and city health departments and other agencies which administer services for crippled children and the aged or chronically ill. The next largest group is employed by voluntary agencies providing home care services. In 1921, the professional organization of qualified physical therapists, now known as the American Physical Therapy Association, was established. The purpose of the association is to promote the development and improvement of physical therapy as a service and a profession. The basis of eligibility to membership is: graduation from a curriculum in physical therapy approved by the Council on Medical Education of the American Medical Association in collaboration with the American Physical Therapy Association; adherence to the official code of ethics; and compliance with legal requirements for state registration or licensure. The American Registry of Physical Therapists was organized in 1935 and also requires graduation from an approved curriculum as well as successful completion of an examination. II. Statement of Functions A. Responsibilities The functions of physical therapists have been drawn up with the following two factors in mind: 1. Direct service to patients is rendered only on medical prescription. Subsequent service is provided only under continuing medical direction. 2. Responsibilities which relate to teaching, consultation, program planning, and administration are developed in association with the appropriate agency, program, service, or professional personnel. The range of duties and responsibilities of physical therapists is determined by the scope of the agency's total program and organization. In large agencies responsible for health and medical care services, the activities of a physical therapist will include most, if not all, of the following: 1. Direct Services a. Performs physical therapy procedures, evaluations, and diagnostic tests on patients for whom these have been medically prescribed, including: (1) teaching appropriate treatment procedures and supportive activitives to patients and family members; (2) developing needed plans for modifying equipment, appliances, and the physical surroundings in patients' homes or substitute homes; (3) conferring periodically with attending physicians regarding the patient's progress. b. Demonstrates appropriate procedures and use of adaptive equipment to nurses and other personnel for followup services to the patient and family. c. Attends clinics for the purpose of: (1) reporting and discussing patient's progress and receiving directions from attending physicians for physical therapy patient care; (2) rendering direct service including individual and group teaching to patients attending clinic; (3) participating in pre- and postclinic conferences with other members of the staff. 2. Consultation a. Provides advisory and consultation service, to allied professional workers who share responsibility for patient care, regarding the physical therapy program in which patients, parents, and others have been instructed. b. Renders consultation and advisory service on request from agencies, in- FEBRUARY,

3 324 stitutions, organizations, and individuals regarding physical therapy. c. Seeks consultation with other professional personnel as indicated. 3. Professional Education a. Participates in the planning and development of staff inservice educational programs of the employing agency, including the orientation of physical therapy staff and other personnel to the aims and objectives of physical therapy in public health. b.demonstrates procedures to physical therapy students and supervises them in their clinical practice affiliation with the agency. c. On request, participates in the planning, development, and execution of educational programs for other agencies, organizations, and institutions of higher learning. d. Evaluates, assembles, and prepares educational materials for use in teaching, consultation, and advisory service. 4. Community Planning a. Participates in the planning and execution of studies and community surveys directed toward identifying and meeting the health needs of patients, families, and the community. b. Participates in the development of community programs and resources to meet the needs of patients, and of acceptable standards for prevention, treatment, and follow-up. c. Interprets to the community the role of physical therapy in the agency's program. 5. Administration a. Participates in program planning and policy development of the agency. b. Plans physical therapy services for the agency including: (1) organization, administration, and supervision of physical therapy within the agency's total program; (2) assignment of physical therapists to meet the needs of the patients served by the agency; (3) analysis of achievements and unmet needs. 6. Studies, Surveys, and Research Initiates or assists in planning, implementing, and evaluating of studies or surveys to: (1) determine community needs for physical therapy or related services; (2) identify patterns of provision of physical therapy services within the community; (3) evaluate effectiveness of physical therapy programs; (4) test new, adapted, or traditional treatment procedures as to effectiveness, cost, and practicability of application. B. Types of Positions Physical therapy positions in public health agencies show a variety of responsibilities and differences in job titles and classifications. In general, the positions are on three levels: 1. Staff physical therapist is responsible for the provision of physical therapy services to patients and related work as assigned in accordance with the functions already listed. 2. Regional, district, or area consultant or supervisor is responsible within the assigned area for: consultation; supervision of staff physical therapists; development of services; integration of physical therapy with other services; evaluation of services; teaching and participating in surveys, studies, and research; acting as liaison between chief consultant or supervisor and other physical therapy staff; and under certain circumstances providing direct service to patients. 3. The director of physical therapy services is frequently designated as chief consultant or supervisor, and is responsible for: planning, organizing, developing, promoting, directing, and evaluating the service; selecting and supervising physical therapy personnel; coordinating physical therapy with other services; teaching; and participating in surveys and research projects Education A. Basic Education A four-year course of study in a college or university leading to a bacca- VOL. 56. NO. 2, A.J.P.H.

4 9PUALIFICATIONS OF PHYSICAL THERAPISTS laureate degree with the major in physical therapy is the most frequent educational preparation for physical therapists. This curriculum includes basic sciences, survey of medical subjects, and supervised clinical practice. Other individuals earn an undergraduate degree in another field of concentration which includes requirements in the humanities, as well as the biological and physical sciences, after which they complete a postbaccalaureate program of study in physical therapy. Courses of study, regardless of their design, must be approved by the Council on Medical Education of the American Medical Association in collaboration with the American Physical Therapy Association. Graduates of these approved courses of study are eligible to apply for state registration and licensure where it is required. Whether the basic physical therapy education is taken on the baccalaureate or the postbaccalaureate level, curriculum requirements embrace strong liberal education elements in the humanities and social sciences. An individual with a well-rounded education, including communication skills, is more capable of performing in a meaningful way in the broad spectrum of health and medical programs. Coupled with this, there is need for a strong background in the biological and physical sciences upon which the safe and effective use of therapeutic exercise and physical agents is based. Well-designed educational offerings in physical therapy theory and procedures should blend excellence in didactic instruction, correlation of laboratory with clinical problems, and a broadening scope of skills and information which enable the graduate physical therapist to fill a role as a contributing member of the public health team. Test and evaluation procedures, technics of teaching and interviewing, coordination of community and agency programs are but a few of the areas of contributing knowledge. Physical therapy curricula are beginning to include training basic to public health, preventive medicine, and opportunities for clinical education in out-ofhospital programs. Curricula are changing as patterns of medical care are changing. These trends can be expected to continue in the future. B. Advanced Study Graduate physical therapists are utilizing increasing opportunities for advanced study in public health, sociology, anthropology, basic sciences, and other areas of special interest. Increasing numbers are obtaining a master's degree in public health and more can be expected to do so in the next decade. There is a noticeable increase also in doctoral level candidates in sciences such as anatomy and physiology. Increasing numbers of short courses and seminars in public health practices as well as special topics for qualified physical therapists are being offered by universities, including schools of public health. Agencies should provide their physical therapists with the opportunity to attend either the short courses and seminars, or the full course in public health or other postbaccalaureate programs of study. IV. Specific Knowledge, Skills, and Experience by Positions The basic educational preparation obtained in a curriculum of physical therapy (approved by the Council on Medical Education of the American Medical Association in collaboration with the American Physical Therapy Association) provides the knowledge and skills needed to treat patients. A few public health agencies which can at all times provide adequate orientation and readily available supervision by a well-qualified experienced physical therapy supervisor are employing FEBRUARY,

5 recent graduates. The majority of official (governmental) public health agencies require at least one to two years of supervised physical therapy experience following graduation from an approved curriculum prior to employment on the staff level. This experience may be in a hospital, clinic, rehabilitation center, or other facility which serves outpatients. The employing agency has the responsibility of orienting each new worker to the agency's total program, philosophy, and administrative policies. The new worker must have assistance in adapting his knowledge, abilities, and skills to the public health setting, especially in such areas as application of evaluation, testing, and treatment procedures to the home situation, as well as in adaption of equipment, case finding, technics of teaching, interviewing, consultation, and coordination of physical therapy with other services. Registration or licensure in states having Physical Therapy Practice Acts is essential. 1. Staff Physical Therapists should have: a thorough knowledge of the principles and practices of physical therapy; knowledge of growth and development; knowledge of socioeconomic factors affecting patients and families. Education-Baccalaureate degree and graduation from an approved physical therapy curriculum. Experience-Minimum of one year of full-time paid experience in physical therapy in a hospital, clinic, or other facility or agency, under the direction of an experienced qualified physical therapist who maintains close supervision at all times. Recent graduates of approved curricula, which include didactic as well as clinical experience in public health, may be eligible for employment by public health agencies which can provide close physical therapy supervision at all times. Personal Qualifications - Ability to 326 administer physical therapy procedures and tests; ability to adapt equipment to the public health setting; ability to learn to work with patients, families, and others in out-of-hospital public health situations; ability to maintain effective working relationships with others; ability to grow professionally; physical fitness; emotional stability; personal and professional integrity. 2. Regional, District, or Area Consultants or Supervisors should have: knowledge of basic public health principles and practices; considerable knowledge of community resources in the area; knowledge of effective methods of supervision; knowledge of interviewing technics and methods of adapting physical therapy principles and practices to the public health setting; knowledge of growth and development; knowledge of cultural and socioeconomic factors affecting patients, families, and the community. Education-Graduation from an approved physical therapy curriculum, including possession of a baccalaureate degree; some advanced preparation in public health principles and practices, or in subjects related to agency's program. Experience-Minimum of three years of full-time paid experience in physical therapy, including one year under the supervision of an experienced qualified physical therapist in a hospital, clinic, or other facility or agency which maintains close supervision at all times. In addition, one year of experience in a public health agency and one year in a supervisory or administrative capacity are desirable. Personal Qualifications-Ability to supervise physical therapy staff; ability to establish and maintain constructive working relationships; ability to provide consultation; ability to administer and adapt physical therapy procedures and practices to the public health setting; ability to teach individuals and VOL. 56, NO. 2. A.J.P.H.

6 QUALIFICATIONS OF PHYSICAL THERAPISTS groups; ability to maintain significant records; physical fitness and emotional stability; personal and professional integrity. 3. Chief Consultant, Supervisor, or Director should possess: knowledge and understanding of the principles of public health administration, organization, and practice; an understanding of the socioeconomic factors which affect health and medical services; knowledge and skill to assess communities-their needs and resources; skill in providing leadership and consultation and in developing working relationships with other professional workers and groups. Education-Baccalaureate degree and graduation from an approved physical therapy curriculum. Some advanced preparation through organized educational courses or institutes in public health principles and practices, community organization, and categorical specialty subjects is desirable. A master's degree in some area of public health or subject related to the agency's program should be required, although hitherto extensive experience in public health practice has been accepted in lieu of a master's degree. Experience-A minimum of four years of full-time paid experience in the practice of physical therapy. It is desirable that this experience should include one year in a hospital, clinic, other facility, or agency under the close supervision of a qualified experienced physical therapist, one year in a supervisory capacity in a hospital, clinic, or other facility serving outpatients, and one year as a supervisor in a public health agency (or two years as a public health physical therapy consultant or supervisor of an area). In some agencies a year of physical therapy experience in a specialty such as pediatrics, geriatrics, or specific diagnostic categories is required. Personal Qualities-Ability to plan, organize, administer, direct, and supervise personnel; ability to develop and maintain effective working relationships with other professional workers and groups; ability to analyze situations and take appropriate action; ability to prepare and present materials; ability to participate in educational activities; ability to recruit personnel; ability to provide leadership; ability to communicate clearly and intelligently; physical fitness and emotional stability; personal and professional integrity. CHARLES E. SMITH, M.D., Chairman BERWYN F. MATTISON, M.D., Secretary JAMES L. TROUPIN, M.D., Associate Secretary RALPH H. BOATMAN, Ph.D. DONALD J. GALAGAN, D.D.S. JOHN C. HUmE, M.D. JOHN E. KIKER, JR., P.E. COMMITTEE ON PROFESSIONAL EDUCATION (1965) W. HARDING LE RICHE, M.D. W. FRED MAYES, M.D. LELAND E. POWERS, M.D. GEORGE G. READER, M.D. KATHRYN A. ROBESON, R.N. ToM F. WHAYNE, M.D. The Committee on Professional Education expresses grateful appreciation to the Subcommittee on Educational Qualifications of Physical Therapists in Public Health Agencies which assisted with the preparation of this report. This subcommittee consisted of: JEROME S. TOBIS, M.D., Chairman GEORGE G. READER, M.D., Referee JESSE B. ARONSON, M.D. CLARA M. ARRINGTON JOSEPH H. GERBER, M.D. OPAL GOODEN GERALD D. LAVECK, M.D. MARGARET L. MOORE SYDNEY S. NORWICK, M.D. HELEN H. VAUGHN FEBRUARY. 1,

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