Therapy Project Office Back to Work Courses Scoping the Need 2008
THERAPY PROJECT OFFICE...3 EXECUTIVE SUMMARY...4 PROJECT AIM...4 INTRODUCTION...4 METHODOLOGY...6 Speech and Language Therapy... 6 Physiotherapy and Occupational Therapy... 7 RESULTS...8 Physiotherapy... 8 Occupational Therapy... 10 Speech and Language Therapy... 11 DISCUSSION...12 RECOMMENDATIONS...13 REFERENCES...14 APPENDICES...15 Appendix 1... 16 Return to Practice Guidelines... 16 Appendix 2... 19 Results from Physiotherapy Manager Back to Work Survey.... 19 Appendix 3... 20 Results from Occupational Therapy Manager Back to Work Survey.... 20 Appendix 4... 21 Mutual Recognition Agreement, IASLT... 21 Appendix 5... 22 Physiotherapy Back to Work Survey... 22 2
Therapy Project Office The Therapy Project Office was established in January 2007 to progress and initiate project activities on behalf of the National Implementation Group (NIG) for Clinical Placement Provision for Occupational Therapy, Physiotherapy and Speech and Language Therapy. The projects related to a number of key actions identified by The Report of the National Planning Group on Clinical Placement Provision for Occupational Therapy, Physiotherapy and Speech and Language Therapy (2004), under the three broad areas of: Practice Education Continuing Professional Development Quality Information for the Public The Therapy Project Office was funded by the HSE and staffed by three project managers, representing the professional bodies of the Association of Occupational Therapists of Ireland (AOTI), the Irish Society of Chartered Physiotherapists (ISCP) and the Irish Association of Speech and Language Therapists (IASLT). A collaborative, project management model was applied throughout the process. The Project Managers also worked in partnership with the Higher Education Institutes, Therapy Services, the Department of Health & Children and the Health Service Executive to build on existing work and to drive the projects forward. 3
Executive Summary This project sets out to scope the need for a Back to Work course for therapists within the three professions (Occupational Therapy, Physiotherapy and Speech and Language Therapy) who wish to return to practice following a period of extended leave. An online survey was carried out to assess the experiences and views of therapy managers across the three professions. The outcome of the survey suggests that currently, there is no great demand for a Back to Work course. In making future recommendations, the potential for collaboration between the three professions in developing such a course is recognised. Project Aim The aim of this project was: To scope the need for a Back to Work course in the professions of Occupational Therapy, Physiotherapy and Speech and Language Therapy. Introduction Background There are currently no courses within the Republic of Ireland designed specifically to support members of these professional groups who wish to return to practice following a period of extended leave. This project sets out to scope the need for such a course by assessing the experiences and views of therapy managers across the three professions. Rationale for Back to Work Courses The rationale for a Back to Work course is to enable practitioners returning to practice to update their theoretical knowledge and clinical skills as well as to facilitate the attainment of competence and confidence. Such a rationale has been given by An Bord Altránais (the statutory regulating body for Nursing and Midwifery in Ireland) for approving the Returning to Nursing Practice courses in 2005. While nurses have no legal requirement to complete a back to work course, An Bord Altranais recommend that they do so and 4
suggest that it falls within the remit of employers to insist that such a course is completed, prior to commencement of employment (2005:4) Currently, Occupational Therapists, Physiotherapists and Speech and Language Therapists in Ireland are not subjected to statutory registration. However, the establishment of the Health and Social Care Professional Council in March of this year will see through the enactment of the Health and Social Care Professionals Act (2005) which will provide for a system of statutory registration for twelve health and social care professions, including Occupational Therapy, Physiotherapy and Speech and Language Therapy. It is within this context of ensuring high standards of competence in order to protect the public that consideration of the requirements for returning to practice takes on relevance. Back to Work Requirements: The UK In the UK the Health Professions Council (HPC) has drawn up and introduced return to practice requirements. The HPC is the UK statutory regulator for Allied Health Professionals. It sets the standards for professional training, performance and conduct for the professions that it regulates in accordance with the Health Professions Order (UK, 2001) 1. In relation to therapists in the UK who are retuning to work after a period of absence greater than two years, the HPC requires a period of updating knowledge and skills before they can be registered again. The length of this period varies according to how long the applicant has been out of practice. In support of these registration requirements, The Chartered Society for Physiotherapy (CSP) in the UK has drawn up guidelines in this area to support their members. The first document is a Return to Practice Guidance Pack. This is available to therapists who wish to return to work after a career break and wish to find out more about: Initial considerations during the career break Periods of re-orientation HPC requirements for Returners to Practice Occupational settings Support for returners UK funding for returners 1 www.hpc-org.uk 5
Existing Return to Clinical Practice course providers Useful contacts The second document the CSP provide is a curriculum framework for return to practice courses designed to provide guidance to actual or potential course providers of Return to Clinical Practice in Physiotherapy programmes. Similarly in Occupational Therapy, the British Association of Occupational Therapists (BAOT) has produced guidelines and practical advice for members who are returning to practice 2 (2007). As for Speech and Language Therapy in the UK, The Royal College of Speech and Language Therapists (RCSLT) have developed a distance learning course for therapists returning to practice. This has been developed in response to evidence gained from a survey of Workforce Development Confederations, Strategic Health Authorities and UK country Health Departments that there is a need to support Speech and Language Therapists returning to practice. (Appendix 1) Methodology Speech and Language Therapy The first of the professional groups in Ireland to actively scope the need for Back to work courses were the Irish Association of Speech and Language Therapists (IASLT). The concept of having a Back to Work course for therapists wishing to return to practice following a period of extended leave initially arose in 2006 as part of the Mutual Recognition Agreement (See Appendix 4.) In 2006 a survey was generated by the IASLT Professional Development and Ethics Committee and sent via email to managers on the managers group mailing list. There were responses from 20 managers. The responses indicated that at that time only 2 managers had had enquiries from therapists wishing to return to work following a period of extended leave. As there were only a small number of returnees it was not a priority to develop a Back to Work course at that time. 2 www.cot.org.uk 6
Based on the outcome of that survey Return to Practice Guidelines were developed (Appendix 1). The guidelines indicate that the Return to Practice procedure must be followed if a Speech and Language Therapist is applying to join/re-join IASLT and has not practiced for two years or more. The procedure is laid out in terms of the length of time that the applicant has not practiced. The guidelines also state that participation in a Return to Practice Course is required if a therapist has been out of practice for more than 5 years. Relevant issues not addressed in the Return to Practice Guidelines include the amount of experience a therapist has had before taking an extended leave from practice. For example, a therapist who has practiced for 20 years before taking a career break will need a different level of support and re-integration to a therapist who has worked for one year and then taken an extended break from clinical work. Therefore the recommendation arising out of the IASLT research is that it is important that a period of supervised practice is individualised for the returning therapist in conjunction with their manager. Physiotherapy and Occupational Therapy Prior to this project being undertaken by the Therapy Project Office, no research had been carried out by Occupational Therapy or Physiotherapy in relation to scoping the need for a Back to Work Course. In order to gather information, a questionnaire was devised based on the work done by IASLT in 2006 (See Appendix 5). The questionnaire was administered using Survey Monkey, an online survey resource tool. The details of how to complete the survey were sent to 75 Physiotherapy managers and 107 Occupational Therapy managers. The managers were given 2 weeks to complete this online survey. Speech and Language Therapy While Speech and Language Therapy (SLT) already had the outcomes from the 2006 survey, an updated questionnaire regarding enquiries from returnees was included as part of this survey (Questions 1-4 Appendix 5). The updated questionnaire was circulated to all Speech and Language Therapy managers (N=83) via a group email with an online link to the survey monkey site. The survey consisted of only three questions and sought information regarding enquiries from returnees only. 7
Results Physiotherapy Number of Back to Work Physiotherapists 30 Physiotherapy managers (4 response rate) replied to this survey.of these only 2 of respondents had being approached by therapists wishing to return to work after having been away from practice for over 2 years (a total of 9 therapists). The number of years that these 9 therapists had been away from practice is laid out in table 1 below. Table 1: Number of years away from practice for Physiotherapists wishing to return to work Physiotherapy Years out of practice Number of therapists 2-5 years out 6 5-10 years out 2 Over 10 years out 1 Physiotherapy Managers opinions gathered in this survey Views were sought from the Physiotherapy managers regarding what type of reintroduction they thought was necessary for therapists returning to work. They were asked specifically for their opinions regarding a period of supervised practice and a period of academic study. The outcomes are described in the text below and summarised in chart format in Appendix 2. For Therapists less than 2 years away from practice: 33% of Physiotherapy managers felt that no period of supervision or academic course was necessary for a therapist returning to work 27% felt that both a period of supervised practice and a period of academic study was needed 23% felt that only a period of supervised practice was needed 17% felt that only a period of academic study was needed. 8
For Therapists 2-5 years away from practice: 67% of Physiotherapy managers felt that a period of both supervised practice and a period of academic study were needed 3 felt that only a period of supervised practice was needed 3% felt that only a period of academic study was needed It must be noted that 10 of managers felt that something was needed for therapists returning to work after an absence of 2-5 years whether this was supervised practice, a period of academic study or both. For Therapists 5-10 years away from practice: 97% of Physiotherapy managers felt that a period of both supervised practice as well as academic study was needed for therapists returning to work after an absence of 5-10 years Only 3% felt that therapists needed nothing more than a period of supervised practice 43% advocated for a week of academic study with 33% advocating for 4 weeks supervised practice Finally for Therapists over 10 years away from practice, managers recommended unanimously that a period of both academic study and supervised practice was needed. 5 of managers felt this should be an academic term 9 advocated for at least 6 weeks of supervised practice 3 recommended over 12 weeks of supervised practice was needed. 9
Occupational Therapy Number of Back to Work Occupational Therapists 25 Occupational Therapy managers (23% response rate) completed the survey. Of those who responded only 3 managers (12%) had being approached by therapists wishing to go back to work after an absence of over two years (a total of 5 therapists). Table 2: Number of years away from practice for Occupational Therapists wishing to return to work Occupational Therapy Years out of practice Number of therapists 2-5 years out 2 5-10 years out 3 Over 10 years out 0 Occupational Therapy Managers opinions gathered in this survey Views were sought from Occupational Therapy (OT) managers regarding what type of reintroduction they thought was necessary for therapists returning to work. They were asked specifically for their opinions regarding a period of supervised practice and a period of academic study. The outcomes are described in the text below and summarised in chart format in Appendix 3. For Therapists less than 2 years away from practice: 32% of OT managers felt that neither a course nor a supervised period of practice was needed 36% felt that a period of supervised practice was needed 4% felt that a period of academic study alone was needed ne of the OT managers felt that both a period of supervised practice and a period of academic study was needed for therapists returning to work after an absence of less than two years. 10
For Therapists 2-5 years away from practice: 72% of OT managers felt that a period of both supervised practice and academic study was needed 24% thought that only needed a period of supervised practice was needed 4% of managers felt that neither was needed. For Therapists 5-10 years away from practice: 10 of managers felt that both a period of supervised practice as well as a period of academic study was needed. (The time periods for each are outlined in Appendix 3.) For Therapists over 10 years away from practice: 10 of managers felt that both a period of supervised practice as well as a period of academic study was needed. (see Appendix 3 for more detail) Speech and Language Therapy Updated Survey A total of 30 managers responded to the survey (36% response rate). 9 of respondents said that they had not been approached in the past two years by therapists wishing to return to work following a period of extended leave. Of the 1 who had been approached there had only been enquiries from 6 therapists wishing to re-enter the workforce. Speech and Language Therapy. Years out of practice Number of therapists 2-5 years out 5 5-10 years out 2 Over 10 years out 0 11
Discussion The aim of this project was to scope the need for a Back to Work course in the Republic of Ireland within the three professions of Occupational Therapy, Physiotherapy and Speech and Language Therapy. Based on the information received from therapy managers, there appears to be a very small number of therapists enquiring about returning to work after significant periods of absence. The survey reported on a total of twenty therapists, across the three professions who had approached managers about returning to practice in the last 2 years. (Physiotherapy N=9, Occupational Therapy N=5 and Speech and Language Therapy N=6). It should be noted that this survey has been limited to therapy managers. It does not take into account the number of therapists who may have made enquires to the Professional Bodies, as this information is not recorded nor did it consider the number of returning therapists who may have approached the Therapy Courses in relation to Back to Work courses. Based on the outcomes of this survey, there does not appear to be a current need for a Back to Work course. Of interest to this discussion is the similarity of outcomes from a more in depth survey undertaken by the Department of Health, Social Services and Public Safety in rthern Ireland in 2002 as part of an overall review of the Occupational Therapy workforce. Despite a recommended follow up action of placing large adverts in widely read newspapers seeking levels of public interest in Return to Work courses, there were virtually no respondents (DHSSPS 2002: 53). While there does not appear to be a current demand for Back to Work courses, it is suggested that in the interest of promoting professional standards of practice, within the professions of Physiotherapy and Occupational Therapy, consideration should be given to defining what length of time away from practice constitutes return to practice. Consideration should also be given to guiding returning therapists on updating their knowledge and practice skills in order to be deemed competent to practice. It will be the new Health and Social Care Professionals Council who will have the responsibility for statutory registration and as such who will define the registration requirements for therapists returning to practice. It is proposed that the Professional Bodies have a valuable role to play in initiating research such as this project and in drawing up guidelines and practical advice for therapists returning to work. If a Back to Work course were to be developed in the future, there would be a need to define the course curriculum. Again there is a valuable role for the Professional Bodies to play in leading this guidance on a 12
curriculum framework which could be done along similar lines to the curriculum guidance offered by the Chartered Society of Physiotherapists in the UK. Recommendations for future work are provided below: Recommendations AOTI and the ISCP should develop guidelines and procedures similar to those of the IASLT for therapists who wish to return to work after a significant period of absence from practice. These guidelines should clearly define what length of time away from practice constitutes return to practice. Particular attention should also be given to guiding returning therapists on updating their knowledge and practice skills. These guidelines and procedures from the Professional Bodies should be made available to the HSCPC for their information. If a Back to Work course was part of these procedures the Professional Bodies should collaborate to develop a multidisciplinary curriculum framework and agree on how and where best to deliver such courses. Supervised Practice should be defined in any future development of back to work requirements. Future developments of back to work requirements should be accommodating of individualised pathways to meet the varied levels of support and preparation needed for therapists who have been absent from the workforce under varied conditions. 13
References An Bord Altranais (2005) Return to Nursing Practice Course Requirements. An Bord Altranais. Ireland College of Occupational Therapists (2007) Returning to Practice, COT/BAOT Briefing 25. UK CSP UK website for all documentation at www.csp.org.uk Department of Health, Social Services and Public Safety (2002) Review of the HPSS Occupational Therapy Workforce cited in College of Occupational Therapists (2007) Returning to Practice, COT/BAOT Briefing 25. UK Geraghty A. (2004 (vember)), IASLT Update, Mutual Recognition of Credentials between The American Speech-Language-Hearing Association (ASHA), The Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA ), The Royal College of Speech and Language Therapists (RCSLT) and The Speech-Pathology Association of Australia Ltd (Speech Pathology Australia). Health and Social Care Professionals Act 2005. Dublin: Stationery Office Health Professions Council (2006) Returning to Practice London HPC http/ww.hpc-uk.org/assets/documents/10001364returning to practice.pdf RCSLT website for all documentation www.rcslt.org Van der Gaag, A. (2004) Speech and Language Therapists and Return to Practice. Report to RCSLT Council, September 2004. 14
Appendices 15
Appendix 1. Irish Association of Speech and Language Therapy. I.A.S.L.T. Return to Practice Guidelines 3 3 www.iaslt.com info@iaslt.com 16
The Irish Association of Speech & Language Therapists (IASLT) acknowledges the need to facilitate and encourage Speech & Language Therapists who have not practiced for a period of time to renew their membership. Speech & Language Therapists who were previously members or eligible for membership and who have not practiced for 2 years or more must re-apply for full membership of IASLT following the Return to Practice procedure. The purpose of having a separate procedure for Speech & Language Therapists returning to practice is to facilitate the applicant by providing a structured programme for returning. This should enable the applicant to update professional knowledge and skills. In some circumstances a reduction / extension of the programme may be applied depending on the individual circumstances (e.g. related postgraduate studies as opposed to personal leave with no CPD activity). This will require consideration and approval by the Chair of the Professional Development and Ethics Committee in conjunction with the Return to Practice Officer. Return to Practice Procedure The Return to Practice Procedure must be followed if a Speech and Language Therapist is applying to join/re-join IASLT and has not practised for 2 years or more. The procedure also applies if a Speech and Language Therapist applies to change membership from nonpractising to full membership and has not practised for 2 years or more. The procedure is laid out in terms of length of time that the applicant has not practised. 2-5 years If a Speech & Language Therapist was previously a member of IASLT or eligible for membership the following steps are required when applying for IASLT membership. Evidence of self-directed study / Continuing Professional Development. This may be submitted on the IASLT CPD log. Supervised practice: A minimum period of 120 hours of direct supervised practice is normally required. The period of supervised practice is designed to offer support in refreshing clinical skills and to ensure clinical competence. This period may be extended dependant on the learning contract that is developed with the supervisor. It is the responsibility of the Speech & Language Therapist returning to the practice to organise the period of supervised practice. When applying for IASLT membership the applicant must submit evidence of the above to the Return to Practice Officer on the Professional Development Committee. 17
6-10 years If a Speech & Language Therapist that was previously a member of IASLT or eligible for membership has not practiced for 6-10 years the following steps are required when applying / re-applying for IASLT membership. Evidence of self-directed study. This may be submitted on the IASLT CPD log Participation in a Return to Practice Course Supervised practice. A minimum period of 240 hours of direct supervised practice is required. The period of supervised practice is designed to offer support in refreshing clinical skills. This period may be extended dependant on the learning contract that is developed with the supervisor. It is the responsibility of the Speech & Language Therapist returning to the profession to organise the period of supervised practice. When applying for IASLT membership the applicant must submit evidence of the above to the Return to Practice Officer on the Professional Development Committee. 10 years or more If a Speech & Language Therapist that was previously a member of IASLT or eligible for membership has not practiced for 10 years plus, the following steps are required when applying for IASLT membership. Participation in a Return to Practice Course Supervised practice. A minimum period of 360 hours of supervised practice is required. The period of supervised practice is designed to offer support in refreshing clinical skills and to achieve clinical competence. This period may be extended dependant on the learning contract that is developed with the supervisor. It is the responsibility of the Speech & Language Therapist returning to the profession to organise the period of supervised practice. When applying for IASLT membership the applicant must submit evidence of the above to the Return to Practice Officer on the Professional Development Committee. IASLT, OCT 2006 18
Appendix 2 Results from Physiotherapy Manager Back to Work Survey. Years out of practice Combination of supervised practice and academic study If yes to a period of supervised practice How long? If yes to a period of academic study, how long? Less than 2 Yes to both Yes academic Yes supervision Neither 26.7% 16.7% 23.3% 33.3% 2 weeks 4 weeks 6 weeks 8 weeks 46.7% 3 1 6.7% 6.7% 1-2 day 1 week 4 week 6 16.7% 2 3.3% 2-5 years out Yes to both Yes academic Yes supervision 66.7% 3.3% 3 2 weeks 4 weeks 6 weeks 8 weeks 12 weeks 6.7% 4 26.7% 1 1 6.7% 1-2 day 1 week 4 week 8 week 3 2 23.3% 23.3% 3.3% 5-10 years out Yes to both Yes academic Yes supervision 96.7% 3.3% 2 weeks 4 weeks 6 weeks 8 weeks 12 weeks longer 0 3.3% 33.3% 26.7% 6.7% 2 1 1-2 day 1 week 4 week 8 week Academic term 3.3% 6.7% 43.3% 16.7% 1 2 Over 10 years out Yes to both 10 2 weeks 4 weeks 6 weeks 8 weeks 12 weeks longer 0 3.3% 6.7% 10 23.3% 26.7% 3 1-2 day 1 week 4 week 8 week Academic term 1 26.7% 13.3% 5 19
Appendix 3 Results from Occupational Therapy Manager Back to Work Survey. Years out of practice Combination of supervised practice and academic study If yes to a period of supervised practice How long? If yes to a period of academic study, how long? Less than 2 Yes to both Yes academic Yes supervision Neither 28% 4% 36% 32% 2 weeks 4 weeks 6 weeks 8 weeks 44% 24% 32% 1-2 day 1 week 4 week 64% 2 8% 2-5 years out Yes to both Yes academic Yes supervision Neither 72% 24% 4% 2 weeks 4 weeks 6 weeks 8 weeks 12 weeks 4% 36% 28% 12% 12% 8% 1-2 day 1 week 4 week 8 week Academic term 24% 28% 32% 12% 4% 5-10 years out Yes to both 100 2 weeks 4 weeks 6 weeks 8 weeks 12 weeks longer 0 8% 16% 32% 12% 28% 4% 1-2 day 1 week 4 week 8 week Academic term 2 32% 32% 8% 8% Over 10 years out Yes to both 10 2 weeks 4 weeks 6 weeks 8 weeks 12 weeks longer 0 16% 8% 4% 32% 4 1-2 day 1 week 4 week 8 week Academic term 12% 44% 16% 28% 20
Appendix 4 Mutual Recognition Agreement, IASLT. The Mutual Recognition Agreement (MRA) came into effect in January 2005. The agreement was initially made between the American Speech-Language-Hearing Association (USA), the Canadian Association of Speech-Language Pathologies and Audiologists (Canada), the Royal College of Speech and Language Therapists (UK) and the Speech Pathology Association of Australia Ltd (Australia). The Irish Association of Speech and Language Therapists (Ireland) applied to join the Accord in February 2005 and RCSLT was appointed to be their mentor through the process. The Agreement is based on mutual recognition of credentials and is not a reciprocity agreement. The purpose of the MRA is to establish a transparent, robust and professionally and ethically sound basis for mutual recognition by one signatory organisation of the credentials of Speech-Language Pathologists granted by each of the other signatory associations. Geraghty A. (2004 (vember)), IASLT Update, Mutual Recognition of Credentials between The American Speech-Language-Hearing Association (ASHA), The Canadian Association of Speech-Language Pathologists and Audiologists (CASLPA ), The Royal College of Speech and Language Therapists (RCSLT) and The Speech Pathology Association of Australia Ltd (Speech Pathology Australia). 21
Appendix 5 Physiotherapy Back to Work Survey 1. What is your job title? Physiotherapy manager Deputy physiotherapy manager Other 2. In the past two years, have you been approached / had job applications from therapists wishing to return to work after an extended period of leave (greater than 2 years away from clinical practice)? Yes 3. If you answered yes to the previous question, approximately how many therapists have approached you wishing to return to work? Number of Therapists 4. How long had these therapists been away from practice? (Please enter the number(s) of therapists below) Less than 2 years 2-5 years 5-10 years Over 10 years 5. In your opinion, if a therapist has not practiced for a certain period what should they undertake to re-enter the workforce? Less than 2 years out of practice 2-5 years out of practice 5-10 years out of practice over 10 years out of practice Supervised practice Academic study Combination of supervised practice and academic study. 6. Do you have any other comments relating to the need for back to work courses? 22