SUPPORT PERSONNEL in OCCUPATIONAL THERAPY Background Paper:

SUPPORT PERSONNEL in OCCUPATIONAL THERAPY Background Paper: Development of a Practice Profile for Support Personnel in Occupational Therapy in Canada: Environmental Scan Prepared for CAOT by: Management Dimensions Inc. April 2007

TABLE OF CONTENTS 1. PURPOSE of PAPER and PROJECT BACKGROUND... 1 1.1 Purpose of Paper... 1 1.2 Background: Occupational Therapy Practice Profile Project... 1 2. THE FRAMEWORK for the OCCUPATIONAL THERAPY PROFILE of PRACTICE in CANADA... 2 2.1 The CanMEDS Framework... 2 2.2 Use of the CanMEDs Framework for the Occupational Therapy Practice Profile... 3 3. AN ENVIRONMENTAL SCAN OF CURRENT PRACTICE AND EDUCATION OF SUPPORT PERSONNEL IN OCCUPATIONAL THERAPY... 4 3.1 The Canadian Context... 4 3.1.1 Guiding Documents Prepared by the CAOT... 4 3.1.2 Education... 5 3.1.3 Education Standards and Accreditation... 6 3.1.4 The Regulatory Context... 7 3.1.5 Practice Context...8 3.2 The International Context... 10 3.2.1 Australia...10 3.2.2 United Kingdom...11 4. BEST PRACTICES IN PRACTICE PROFILE DEVELOPMENT... 17 5. DEVELOPMENT OF THE PRACTICE PROFILE for SUPPORT PERSONNEL in OCCUPATIONAL THERAPY... 17 5.1 The Approach and Scope of the Framework... 17 5.2 Data Gathering and Job Analysis... 20 5.3 Next Steps... 21 REFERENCES... 22 Appendix 1.... 24 List of Occupational Therapy Support Personnel Education Programs in Canada... 24 i

1. PURPOSE of PAPER and PROJECT BACKGROUND 1.1 Purpose of Paper The purpose of this paper is to provide background information for the development of a practice profile for support personnel in occupational therapy in Canada. The paper will focus on three main areas: i) Inventory past initiatives related to support personnel in occupational therapy, and work completed to date about support personnel within the project to develop the Occupational Therapy Profile of Practice in Canada; ii) Describe the Canadian and international contexts related to support personnel, including information about education, titles and employment; and relevant international models for support personnel in occupational therapy, in particular the approaches used in Great Britain and Australia. iii) Provide information about job analysis and analysis of practice approaches for development of practice profiles. 1.2 Background: Occupational Therapy Practice Profile Project A number of documents have been developed related to competencies for occupational therapy practice in Canada including: A Profile of Occupational Therapy Practice in Canada, which was published by the Canadian Association of Occupational Therapists (CAOT) in 1996 and described occupational therapy practice in Canada and the competencies required by occupational therapists; A Profile of Occupational Therapy Practice in Canada 2 nd Edition was published in 2002 1 with the purpose of providing a description of the performance expectations related to the roles and functions of occupational therapists in Canada (CAOT, 2002a, p.2). Essential Competencies of Practice for Occupational Therapists in Canada 2 was published by the Association of Canadian Occupational Therapy Regulatory Organizations (ACOTRO) to outline the performance indicators (knowledge, skills and abilities) for competencies that had previously been identified by members of ACOTRO. In 2003 ACOTRO published the second edition of the document, which outlined requirements for entry to practice as well as continuing competence of occupational therapists. The CAOT has undertaken the Occupational Therapy Practice Profile Project which aims to update and revise the current Profile of Occupational Therapy Practice in Canada (2002) to reflect the continuum of performance expectations needed for current and emerging occupational therapy practices. 3 The project is being led by Management Dimensions Inc. and is guided by an Advisory Group, whose members 1 Canadian Association of Occupational Therapists, 2002a 2 Association of Canadian Occupational Therapy Regulatory Organizations, 2003 3 Management Dimensions, 2006 Support Personnel in Occupational Therapy: Background Paper 1

were appointed by the CAOT. The resulting Profile will identify the requisite competencies for safe, quality practice and will advance a model for excellence in practice, embracing three types of practitioners: competent occupational therapists, occupational therapists that are proficient and support personnel in occupational therapy. To date, multiple drafts of the new Profile were developed and reviewed by the Advisory Group and revised to reflect the input received. Validation of the Occupational Therapy Profile of Practice in Canada (Draft 5) began in April 2007 and the validated Profile is scheduled for completion in late 2007. Next is the planned development of a Practice Profile for Support Personnel in Occupational Therapy in Canada will be conducted in three phases: Phase 1 - Conceptual Design Development Phase 2 - Profile Development Phase 3 - Profile Validation and Final Development It is planned that the Support Personnel Project is completed in 2008. 2. THE FRAMEWORK for the OCCUPATIONAL THERAPY PROFILE of PRACTICE in CANADA 2.1 The CanMEDS Framework In September 2005, the Royal College of Physicians and Surgeons of Canada (RCPSC) published a revised version of its competencies framework for medical specialists, called the CanMEDS Roles 4, which is an acronym for Canadian Medical Education Directives for Specialists. The CanMEDS competencies have been integrated into the RCPSC accreditation standards, objectives of training, final in-training evaluations, exam blueprints, and the Maintenance of Certificate program. The competency-based framework identifies the core abilities of specialists and is organized thematically around seven meta-competencies or Roles: Medical Expert (central integrative Role), Communicator, Collaborator, Health Advocate, Manager, Scholar and Professional. The interrelationships of the Roles in the CanMEDS framework are depicted as a cloverleaf or daisy with the Medical Expert role in the centre surrounded by the remaining six roles. This model is depicted in Figure 1. The framework uses a modified functional analysis approach and includes a definition and description for each of the seven Roles as well as key competencies and enabling competencies. Each of the competencies is further described in terms of expected performance outcomes. A 4 Frank, 2005. Support Personnel in Occupational Therapy: Background Paper 2

sample of the organization of the CanMEDS Framework for the Medical Expert Role is included in Appendix 1. Figure 1. The CanMEDS Framework 2.2 Use of the CanMEDs Framework for the Occupational Therapy Practice Profile In October 2005 the Canadian Association of Occupational Therapists (CAOT) adopted the CanMEDS framework for development of its Occupational Therapy Profile of Practice in Canada (Profile). The framework was then adapted to reflect occupational therapy practice around seven main Roles : Expert in Enabling Occupation, Communicator, Collaborator, Practice Manager, Change Agent, Scholarly Practitioner, and Professional. These seven roles are interconnected, with Expert in Enabling Occupation being the central role. The Profile is based on the fact that occupational therapy requires the mastery of a complex body of knowledge, skills, and attitudes that comprise the art and science of occupational therapy. Support Personnel in Occupational Therapy: Background Paper 3

The Profile includes a Definition and Description for each of the seven roles of occupational therapists. In addition, details are provided about competencies for the different levels of occupational therapy practitioners in these roles including: Key Competencies and Enabling Competencies for the competent occupational therapist; and Key Competencies for the occupational therapist who is proficient. In an appendix to the Profile, basic performance expectations for support personnel in occupational therapy are outlined. The performance expectations reflect that support personnel in occupational therapy demonstrate competence for assigned components of an occupational therapy service. The Profile assumes that the occupational therapist is considered to be responsible for the entire defined practice while support personnel carry out assigned work activities within a practice relationship with the occupational therapist. The performance expectations outlined in the Profile are based on the specific feedback of the Content Working Group members during the initial validation process of the Profile (and as described in Section 1.2). It was recognized that further development and consultation was needed to complete a Practice Profile for Support Personnel in Occupational Therapy in Canada that encompasses the practice continuum. 3. AN ENVIRONMENTAL SCAN OF CURRENT PRACTICE AND EDUCATION OF SUPPORT PERSONNEL IN OCCUPATIONAL THERAPY 3.1 The Canadian Context 3.1.1 Guiding Documents Prepared by the CAOT Project Summary Report Profile of Performance Expectations for Support Personnel in Occupational Therapy in Canada 5 The purpose of this project was to develop a profile that described the expectations that occupational therapists have of formally trained support personnel that is, entry-level support personnel who have received formal training (i.e. training leading to a certificate or diploma granted by a recognized institution). The intended uses of the profile would be to serve as guidelines for the provision of support services in occupational therapy in Canada and to provide a foundation for the development of educational standards for support personnel (CAOT, 2002b, p2). The profile was developed at a generic level and was based on a functional job analysis model comprising 7 units, 34 elements and 120 performance criteria for support personnel. However, results of the 5 CAOT, 2002b Support Personnel in Occupational Therapy: Background Paper 4

project survey of CAOT members indicated a great degree of variability in the performance expectations, particularly regarding assessment of clients, evaluation of services and participation in management issues. Therefore the CAOT was unable to validate the profile The CAOT Position Statement: Support Personnel in Occupational Therapy Services 6 This statement indicates that the CAOT supports the inclusion of support personnel in the delivery of occupational therapy services, where their contribution will enhance the effectiveness of occupational therapy services. The Position Statement further describes the many different levels of education taken by support personnel (e.g., community colleges, private educational institutions, on-the-job, registered practical nursing, early childhood education) and the wide range of titles they have in the workplace (e.g., rehabilitation assistant, occupational therapy assistant, occupational therapy aide, educational assistant, vocational assistant, health care assistant, health care worker). Guidelines for the Supervision of Assigned Occupational Therapy Service Components 7 This guideline indicates that occupational therapy services are provided by an occupational therapist; however, components of the service may be assigned to another individual such as occupational therapy support personnel or other service provider. The responsibility of an occupational therapist for the supervision of assigned occupational therapy services remains the same regardless of the individual to whom the service component is assigned. This may refer to family caregivers, teaching assistants, support personnel in occupational therapy or technical support workers. Although the methods and frequency of supervision vary, the same three steps of the supervision process should be followed for the provision of occupational therapy services: 1. Task Identification and Analysis 2. Development of Supervision Plan 3. Monitoring and Evaluation of Task Completion 6 CAOT, 2003a 7 CAOT, 2003b 3.1.2 Education In Canada there are 18 support personnel educational programs, which vary greatly in the length of the program and the credential offered: Program Length Nine diploma programs are 4 semesters in length over 2 years; one is 4 semesters over 16 months; one is 5 semesters over 2 years; and one is 11 months. Support Personnel in Occupational Therapy: Background Paper 5

Credential Thirteen programs offer an Occupational Therapist Assistant diploma; four programs offer an Occupational Therapist Assistant certificate; and one program offers an Occupational Therapy Aide diploma. Certificate programs vary in length from 10 months to 5 semesters A list of the current education programs for occupational therapy support personnel in Canada is included in Appendix 2. Some of the additional characteristics of the education programs are that: The majority of the programs include fieldwork experience. The majority of programs (15) offer combined training for an Occupational Therapist Assistant/Physical Therapy Assistant. One program is web based, while another is offered through correspondence; both are certificate courses and include fieldwork. Fourteen programs are offered at provincial community colleges. 3.1.3 Education Standards and Accreditation In Ontario, the Ministry of Training, Colleges and Universities develops vocational learning outcomes or standards for some of the education programs offered at the post-secondary level. The purpose of the standards is to ensure the programs are appropriate and relevant to the needs of students, graduate and employers. 8 For occupational therapist assistant education programs there are currently 16 vocational learning outcomes, each of which is associated with a number of performance elements (a total of 131 elements). In 2006 the Ministry initiated a review of the vocational standards for the newly developed combined Occupational Therapist Assistant/Physical Therapy Assistant (OTA/PTA) programs. It is anticipated that the review, which included stakeholder focus groups and broad consultation, will be completed by the fall 2007. Currently there is no accreditation system in place for the assessment of the quality of support personnel education programs. Discussions have been ongoing since 2003 between the Accreditation Council for Canadian Physiotherapy Academic Programs (ACCPAP) and the educators of support personnel programs regarding the feasibility of developing an accreditation program. In December 2004, ACCPAP completed a Business Plan for Accreditation of Physiotherapist Support Worker Education Programs in Canada, which indicated that there was a high level of support in principle for the development of an accreditation process. Many of the support personnel education programs are now combined, providing both occupational and physical therapist assistant education. Therefore, 8 Ministry of Training, Colleges, and Universities, 2006 Support Personnel in Occupational Therapy: Background Paper 6

discussions were initiated between ACCPAP and the CAOT regarding the potential to collaborate in the development of an accreditation process. In December 2006 the CAOT Board of Directors approved moving forward with this initiative. Discussions are ongoing and plans are being developed to initiate the development of accreditation standards for OTA/PTA education programs. However, completion of the Practice Profile for Support Personnel in Occupational Therapy will be necessary to provide guidance for development of the discipline specific accreditation standard about performance expectations of OTA students at graduation. 3.1.4 The Regulatory Context Provincial regulatory colleges establish guidelines that direct the practice of occupational therapists at the provincial level. It appears that, presently, five jurisdictions publish guidelines that relate to the assignment or delegation of services to unregulated support personnel. All such guidelines are premised on the belief that, while occupational therapists are responsibility for occupational therapy services, service components may be assigned to support personnel in practice situations with appropriate training, assessment and supervision. Although the current regulatory guidelines outline definitions for support personnel and describe aspects of training, assignment, and supervision; standardization does not exist. Support personnel are defined as: New Brunswick (NBAOT, 2002) Quebec (OEQ, 2005) Ontario (COTO, 2004) Manitoba (COTM, 2006) Alberta (ACOT, 2005) British Columbia (COTBC, 2004) No definition Participation of non-ot personnel in the delivery of OT services: accomplishment of clinical activities related to the occupational therapy intervention process by a staff member in a setting where OT services are offered An individual who is not registered with the College of OT and to whom a registered OT may assign tasks related to the delivery of OT services. Note this definition does not apply to student OTs or OT Reg. candidates. Any service provider who is not a qualified OT or student OT yet who is knowledgeable in the filed of OT through experience, education and/or training and is directly involved in the provision of OT services under the supervision of an OT. Any personnel that do not meet the requirements under legislation to be an occupational therapist/restricted practitioner, but as a result of varied education, training, or experience, and under the supervision of an OT, has the competence to provide OT services. These individuals may be referred to by various titles including but not limited to OT Assistant, OT Aide, Support Worker, Rehabilitation Attendant/Assistant, Community Support Worker, and Auxiliary Worker. Any service providers who are not qualified OTs but are knowledgeable in the filed of OT through experience, education and/or training and directly involved in the provision of OT services under the supervision of an OT. Support Personnel in Occupational Therapy: Background Paper 7

3.1.5 Practice Context The occupational therapy practice context, where support personnel work, is important to being able to describe the necessary knowledge, skills and abilities for support personnel to function effectively. The seven tables, based on the information from the annual member s information, highlights information about the current educational background, functions and services related to support personnel in occupational therapy (CAOT, 2007, 2006, 2004). A. Client Ages Client Ages 05-06 NOT incl. all ages 6.3 % Adult -21-64 years 72% Senior -65+ years 59% Child 0-11 years 48% Adolescent -12-20 years 30% Note: respondents can choose more than one age group B. Employer Type Employer Type 05-06 INSTITUTION 59 % General Hospital 23% Paediatric Facility/Education System 16% Rehabilitation Centre 9% Long Term Care/Chronic Care Facility 6% Mental Health Centre 5% COMMUNITY 28% Home/Workplace 22% Community Agency/Group Home/ Recreational Facility/Correctional Facility INDUSTRY & OTHER 13% Private Business/ Professional Service/Retail Business 5% Post Secondary Institution (University/College) 4% Government/Regulatory Body 2% 2% Industry/Workers Compensation Board 2% 6% Support Personnel in Occupational Therapy: Background Paper 8

C. Areas of Practice Areas of Practice 03-04 Mental Health Concerns 89% (e.g., psychotic and neurotic disorders, learning disabilities, eating disorders, substance abuse, delayed development) General Health 80% Concerns (e.g., cancer, chronic pain, cardio-respiratory disease, HIV) Neurological Concerns 79% (e.g., cerebral vascular accident, traumatic brain injury, cerebral palsy, spinal cord injuries) Musculoskeletal Concerns D. Occupational Performance Issues 45% (e.g., orthopaedics, rheumatic diseases, amputations, burns) Performance Components 05-06 Physical 83% Cognitive 68% Affective 43% Spiritual 34% Environmental Conditions Physical 68% Institutional 51% Social 50% Cultural 31% E. Support Personnel Services Services Total number of members who report using support personnel 1394 Total number of respondents 5551 Percentage of members who report using support personnel 25% Services Members who use Support Personnel % of respondents who use these services Occupational life skills 242 17% Functional Mobility 182 13% Seating 119 9% Independent living 109 8% Home care 66 5% Assistive technology 65 5% Hand rehabilitation 63 5% Program coordination/management 63 5% Neurodevelopmental treatment 53 4% Client education 51 4% Cognitive/Perceptual therapy 49 4% Sensory integration 37 3% Primary Health Care 34 2% Orthotics 28 2% Consulting 21 2% Support Personnel in Occupational Therapy: Background Paper 9

F. Background of Support Personnel Do you assign service components to support personnel? 2006-07 Yes % of total 2006-07 No % of total Does not assign to support personnel 2321 42% 3230 58% Assign to support personnel with other training 1670 30% 3881 70% Assign to formally trained support personnel only 1487 27% 4064 73% TOTAL Number Surveyed 5551 100.00% 5551 100.00% G. Functions of Support Personnel Function of Support Personnel 06-07 Client Intervention/Education 38% Management of equipment/supplies 35% Office Administration 29% Program planning and evaluation 9% Client Assessment 3% Total number of members surveyed 100% 3.2 The International Context The education and roles of support personnel in selected countries were reviewed, including those in Australia, the United Kingdom and the United States. Table 1 (at the end of this section) depicts a summary of the various aspects of support personnel that were reviewed including: title, education, types of duties, employment and registration. 3.2.1 Australia Position and Policy Statements The Council of Occupational Therapists Registration Boards (COTRB) is an organization that considers matters of joint or common concern or interest to the Occupational Therapists Registration Boards in Australia and New Zealand. In 2005, the COTRB approved a policy statement about occupational therapy support staff. The policy describes the role of support staff as being to assist occupational therapists in providing an occupational therapy service and clearly outlines work responsibilities and limitations. Occupational therapists are responsible to ensure that support staff are trained appropriately for assigned tasks and are evaluated to ensure their work is safe, effective, efficient and competent. OT Australia, which is the professional association for occupational therapists in Australia, also has a position statement about occupational therapy assistants (OTA). The position statement outlines the OTA roles, education, and Support Personnel in Occupational Therapy: Background Paper 10

supervisory responsibilities of occupational therapists. The statement also indicates that OTAs should possess the following competencies in their relevant areas of practice to ensure the safety and quality of services delivered to clients: Basic human body systems and function Communication skills for establishing rapport Communication skills for reporting Occupational health and safety in health care contexts such as manual handling, infection control and basic first aid Maintain privacy and confidentiality Basic medical terminology In addition, the OT Australia WA Inc 9 published a document in 2005: Occupational Therapy Assistants: Policy Statements and Guidelines. This document includes many details about OTAs including their role, education requirements, supervision, and a code of conduct. A sample list of OTA duties is also included. Competency Standards for Support Personnel A small group of occupational therapists in the state of Victoria undertook a project to develop competency standards for occupational therapy assistants 10. While the sample was small, the research project involved conducting a focus group to develop draft standards; followed by validation through participant observation and critical interviews. The resultant competency standards included seven units of competency and standards expected of occupational therapy assistants in the region. The competencies were further described in a format similar to that of the Australian Standards Framework including units and elements of competency, performance criteria, a range of variables and evidence guides or cues. It is anticipated that these standards will be used for performance management, recruitment, quality of supervision and to guide continuing education. 3.2.2 United Kingdom The Context of Practice for Support Workers: National Service Frameworks All support personnel in occupational therapy are regulated; as are those in what is termed the allied health professions, for example, physiotherapy and dietary. Plans are underway to have all support workers in social care in the United Kingdom (UK) regulated by Skills for Care, the sector skills council for the Social Services Sector. 9 Currently OT Australia is a federated structure of nine separate/autonomous state, territory and national entities; as of a March 2007 Referendum, OT Australia will become one new single entity. 10 Ford, L., & McIntyre, G, 2004 Support Personnel in Occupational Therapy: Background Paper 11

As part of the modernization agenda for the National Health System (Agenda for Change) in the United Kingdom, England, Northern Ireland, Scotland and Wales have developed National Service Frameworks (NSF). The NSFs provide a systematic approach for improving standards and quality across all health care sectors. Part of the responsibility of NSFs is to define service models for care groups and establish performance measures for providers. As the NSFs develop to meet the changing needs of patient populations, those who work within the system may be required to develop knowledge and skills to better meet the needs of patients. Knowledge and Skills Framework The Knowledge and Skills Framework (KSF) is a tool to enable providers to identify the knowledge and skills and their application that are required for a role, or to meet patient needs. For support workers the KSF is linked to the National Occupational Standards. The KSF is designed as a tool to: Provide a focus for learning and development; Identify the knowledge and skills individuals require for their role; Guide development of individuals; and Provide a fair and objective framework on which to base review and development. A National Framework for Support Worker Education and Development To complement the KSF, the Chartered Society of Physiotherapy (CSP) and the College of Occupational Therapists (COT) in the UK jointly developed A National Framework for Support Worker Education and Development (Framework) 11. The Framework is designed as a tool to provide guidance for support personnel to: Identify learning needs, Choose pathways for ongoing learning, Gather evidence of learning and development Assess how learning has addressed gaps in knowledge and skills and Assess how learning is translated into practice. The Framework is intended to apply to all types of support personnel working in occupational therapy, physiotherapy or multidisciplinary teams and in all types of work environments in the National Health System (NHS). The Framework outlines eight key learning outcomes which represent expectations for development of knowledge and skills with increasing complexity throughout the support personnel s career: i) Undertake effective continuing professional development ii) Establish and maintain good communication with others 11 The Chartered Society of Physiotherapy & The College of Occupational Therapists, p. 9 Support Personnel in Occupational Therapy: Background Paper 12

iii) Practice within core areas of support worker practice in line with evidence-based healthcare, national standards and changing demands iv) Demonstrate and apply knowledge and understanding of issues affecting support worker practice v) Support equality for all in allied health professions practice vi) Assist people to optimize their health and social wellbeing and acknowledge their right to make their own decisions vii) Contribute to the delivery of allied health professions services in response to individual need viii) Manage oneself and work with others to optimize results The Framework is founded on the principles of continuing professional development (CPD), which is defined as a range of learning activities undertaken to maintain and develop knowledge and skills for effective and high quality practice 12. The various elements of the learning cycle for CPD are depicted in Figure 2 13. 12 Ibid, p. 13 13 The Chartered Society of Physiotherapy & The College of Occupational Therapists, p. 13 Support Personnel in Occupational Therapy: Background Paper 13

Support personnel are advised to create and maintain a portfolio to record all learning activities, both informal and formal, and to evaluate learning needs on an ongoing basis. The CSP and the COT have developed guides and materials to support their associate members in their development of learning portfolios. One of the supporting documents developed by the COT is: Support Worker Education and Development: Learning opportunities 14. This document outlines a variety of learning opportunities ranging from employer orientation and in-service to educational routes to becoming an occupational therapist. 14 COT, 2005 Support Personnel in Occupational Therapy: Background Paper 14

Table 1: Overview of Support Personnel: International Context Country Title Education Employment Types of Duties Regulation Australia 1516 -Occupational therapy assistants -Also known as occupational therapy support staff or aides or activity supervisors -Support and supplement the work of qualified occupational therapists in the delivery of health care to clients -Directed in duties and supervised by qualified occupational therapists United Kingdom Clinical support workers (sometimes known as therapy assistants or therapy helpers) -Orientation and work-based training -Depends on job requirements and conditions of employment; the employing occupational therapist is responsible to determine the scope of training required by the occupational therapy assistant -OT Australia recommends a minimum of Certificate III or equivalent education/training from an appropriate registered training organization -Training is often provided onthe-job. -Entry into these positions is through the normal healthcare assistants route -Generally there are no formal entry requirements for occupational therapy support workers -Positions are usually within the NHS, private practice, social services or voluntary organizations and work alongside occupational therapists -Assists in a client s intervention plan; extent of involvement is dependent on the Occupational Therapists Registration Act (OTRA), policies of health facility, needs of client, and capacity/training of the assistant -The employing occupational therapist is responsible to determine the scope of the activity of the occupational therapy assistant -Preparing patients for their therapy -Setting up equipment to use in the session/treatment -Assisting the therapist in the treatment itself -Contributing to record keeping -No regulatory requirements for the assistant; however, the OTRA specifies requirements for supervision of assistants by registered occupational therapists and delegation of tasks -Eligible for registration as an associate member of the regulatory College. 15 http://www.ausot.com.au 16 Australian Association of Occupational Therapists, 2006 Support Personnel in Occupational Therapy: Background Paper 15

Country Title Education Employment Types of Duties Regulation United Kingdom (cont d) however you will need a good general standard of education; some employers may require a vocational training award such as an NVQ in Health -Many occupational therapy support workers study for vocational awards e.g. NVQs/SVQs, to develop their careers as support workers and return to study preregistration programs later in their career. United States 17 Occupational Therapy Assistants Occupational Therapy Aides -Occupational therapist assistants generally must complete an associate degree or a certificate program at an accredited education program -Occupational therapist aides usually receive most of their training on the job; qualified applicants must have a high school diploma, strong interpersonal skills, and a desire to help people in need. -The majority work in hospitals; also in private practices, nursing care facilities, community care facilities for the elderly, home health care services, individual and family services, and State government agencies -Help clients with rehabilitative activities and exercises outlined in a treatment plan developed in collaboration with an occupational therapist. -Occupational therapist assistants are regulated in most States and must pass a national certification examination after they graduate -Those who pass the examination are awarded the title Certified Occupational Therapy Assistant. 17 Support Personnel in Occupational Therapy: Background Paper 16

4. BEST PRACTICES IN PRACTICE PROFILE DEVELOPMENT Competency frameworks provide an opportunity to have one set of criteria/behaviours that can be applied across a profession. Important to the utility of the profile is a picture or framework to guide development. The frameworks describe the essential work of the practitioner of interest (i.e. Support Personnel in Occupational Therapy) rather than trying to capture all behaviours/performance expected for a practitioner. A concise and comprehensive document is more useful as it is easier to implement, more user friendly; and makes it easier to assess the behaviours. In their Competencies Handbook, Whiddett and Hollyforde (1999) describe the quality standards for competency frameworks including that they: Are clear and easy to understand (use simple language and are logical); Are relevant to all who will be affected by the framework (relevancy re: language, roles); Take into account any expected changes (in the profession s environment, technology, future); Have discrete, measurable and meaningful elements, (i.e., behavioural indicators/competencies do not overlap, they relate to only one competency or cluster); and Are fair to all affected by their use (e.g. occupational therapists). 5. DEVELOPMENT OF THE PRACTICE PROFILE for SUPPORT PERSONNEL in OCCUPATIONAL THERAPY This section outlines the processes used in the development of the Practice Profile for Support Personnel in Occupational Therapy. 5.1 The Approach and Scope of the Framework The CAOT determined the adaptation of an established roles based competency framework (Royal College of Physicians and Surgeons of Canada, 2005) for the Occupational Therapy Profile of Practice in Canada. This framework will also serve as the foundation for the Practice Profile for Support Personnel in Occupational Therapy. The Practice Profile is organized around seven main Roles : Expert in Enabling Occupation Defn, Communicator, Collaborator, Practice Manager, Support Personnel in Occupational Therapy: Background Paper 17

Change Agent, Scholarly Practitioner, and Professional. These seven roles are interconnected, with Expert in Enabling Occupation being the central role. Occupational therapy practice requires the mastery of a complex body of knowledge, skills, and attitudes that comprise the art and science of occupational therapy. In day to day occupational therapy practice, depending on the needs of the client Defn and the practice context, different roles are explicitly required. However, what is constant in all occupational therapy practice is the explicit role as Expert in Enabling Occupation. Table 2 outlines the feedback on the involvement of support personnel with the defined roles. Table 2: Roles for Support Personnel in Occupational Therapy ROLE Expert in Enabling Participation Through Occupation Communicator Collaborator Manager Change Agent Scholar Professional Applies to Support Personnel in Occupational Therapy Yes, To some extent (50-67%) Yes ( 80%) Yes, Mostly (67-80%) Yes, In limited manner (10-50%) Yes, To some extent (50-67%) Yes, In limited manner (10-50%) Yes, To some extent (50-67%) Support Personnel in Occupational Therapy Based on the survey of the Working Group, the following Table 3 outlines the assumptions about the relationship of the Support Personnel in Occupational Therapy with the Occupational Therapist Support Personnel in Occupational Therapy: Background Paper 18

Table 3: Relationship of Support Worker in Occupational Therapy and Occupational Therapist WHO Support Personnel in Occupational Therapy FUNCTION(S) WITHIN OCCUPATIONAL THERAPY TEAM Member of Occupational Therapy Team ASSUMPTIONS & EDUCATION REQUIREMENTS Meets core competencies for Support Personnel in Occupational Therapy Formalized training program or structured on the job training Competent Occupational Therapist Leader of Occupational Therapy (OT) Team Member of OT Team Assignment and supervision of work to Support Personnel in OT Team Meets core competencies for Occupational Therapists Master s or Baccalaureate in Occupational Therapy 1 that allows for registration / licensure Based on the results of the survey, Table 4 outlines the revised roles and a preliminary list of basic competencies of Support Personnel of Occupational Therapy. Further work is needed to ensure the accuracy and completeness of these competencies. Table 4: Preliminary List of Basic Competencies of Support Personnel in Occupational Therapy ROLE 1. Expert in Enabling Occupation Basic Competencies of Support Personnel in Occupational Therapy (i.e. WITHIN the practice relationship with the OT) 1a. Function effectively to support the Occupational Therapist as expert in enabling occupation. 1b Establish and maintain knowledge, skills and attitudes appropriate to their work. 1c Seek appropriate consultation from the Occupational Therapist and other appropriate team members, recognizing the limits of their own abilities. 2. Communicator 2a. Develop rapport, trust and ethical relationships with clients. 2b Accurately convey relevant information and explanations to clients, colleagues and others. 2c Convey effective oral and written information. 3. Collaborator 3a Participate as an effective collaborator within the Occupational Therapy and interprofessional teams. 3b Effectively work with others to prevent, negotiate and resolve conflict. Support Personnel in Occupational Therapy: Background Paper 19

ROLE Basic Competencies of Support Personnel in Occupational Therapy (i.e. WITHIN the practice relationship with the OT) 4. Practice Manager 4a Manage priorities to balance client services, work requirements and personal life. 4b Participate in activities that support the effectiveness of client service delivery within the organization. 5. Change Agent 5a Demonstrate awareness of the impact of the determinants of health, wellbeing and equity for the clients that they serve. 5b Support the occupation, occupational potential, and/or occupational performance of individual clients. 6. Scholarly Practitioner 6a. Maintain and enhance personal competence through lifelong learning. 6b. Support the learning of clients and students. 7. Professional 7a. Demonstrate an ethical approach to client services. Table 5 describes the levels with the Profile that must be defined when applying the role-based framework for support personnel in Occupational Therapy. Table 5: Framework for Support Personnel in Occupational Therapy 18 Profile Level Details 1. General Description Two or three brief sentences that reflect the array of performance expectations/ competencies. Provide examples and description of the seamless whole of professional practice. 2. Roles Roles include: - Expert in Enabling Occupation - Communicator - Collaborator - Manager - Health Advocate - Scholar - Professional 3. Key Performance Expectations/Competencies Thematically Grouped by Role 4. Enabling Performance Expectations/Competencies Within each Role there are a small number of specific performance expectations/ competencies. The broad abilities are also described. Enabling competencies are the sub-abilities, made up of knowledge, skills and attitudes that are essential for an individual to attain a larger competency. 5.2 Data Gathering and Job Analysis Given the wide variety of background, the roles and functions for Support Personnel in Occupational Therapy in Canada examples of performance expectations will be used to illustrate how the competencies look in the work setting. The job analysis will highlight the differences in the following areas 19, 20, 21, 18 Frank, 2005, p 33. Support Personnel in Occupational Therapy: Background Paper 20

Duties and Tasks - The basic unit of a job is the performance of specific tasks and duties. Information to be collected about these items may include: frequency, duration, effort, skill, complexity, equipment, standards, etc. Environment - This may have a significant impact on the physical requirements to be able to perform a job, for example, the work environment may include unpleasant conditions or there may be definite risks to the worker. Tools and Equipment - Some duties and tasks are performed using specific equipment and tools. Relationships - Supervision given and received and relationships with internal or external people. Requirements - The knowledge, skills, and abilities (KSA's) required to perform the job. While a worker may have higher KSA's than those required for the job, a Job Analysis typically only states the minimum requirements to perform the job. 5.3 Next Steps A Design Group has been established to contribute to the development of the conceptual/design model for the Practice Profile for Support Personnel in Occupational Therapy. Following development of the framework, the competencies will be determined, validated and finalized. It is intended that the Profile will encompass the practice diversity of support personnel in occupational therapy in Canada. 19 ibid 20 Assessment Strategies, 1998. 21 Fine, S & Cronshaw S., 1999 Support Personnel in Occupational Therapy: Background Paper 21

REFERENCES Assessment Strategies. (1998). Report on the development of the competency profile for the entry-level physiotherapist in Canada. Prepared for the Canadian Alliance of Physiotherapy Regulators, Canadian Physiotherapy Association, Canadian Universities Physical Therapy Academic Council: Toronto Australian Association of Occupational Therapists (WA) Inc. March 2005). Occupational Therapy Assistants: Policy statements and guidelines. Authors: College of Occupational Therapists Regulatory Boards Inc. (October 2005). Policy: Occupational Therapy Support Staff. Available: http://www.cotrb.saboards.com.au/policy-supportstaff.pdf Canadian Association of Occupational Therapists. (2002a). A Profile of Occupational Therapy Practice in Canada 2 nd Edition. Ottawa: Authors Canadian Association of Occupational Therapists. (2002b). Project Summary Report: Profile of performance expectations for support personnel in occupational therapy in Canada. Ottawa: Authors. Canadian Association of Occupational Therapists. (2003a). CAOT Position Statement Support Personnel in Occupational Therapy Services http://www.caot.ca/default.asp?pageid=161 Canadian Association of Occupational Therapists. (2003b). Guidelines for the Supervision of Assigned Occupational Therapy Service Components. Ottawa: Authors Council of Occupational Therapists Registration Boards (Australia and New Zealand) Inc. (October 2005). Policy: Occupational Therapy Support Staff. Authors. Available: http://www.cotrb.saboards.com.au/supportstaff.htm Guidelines for the Supervision of Assigned Occupational Therapy Service Components (2003) http://www.caot.ca/default.asp?changeid=1&pageid=579 Canadian Association of Occupational Therapists (1). (2002). Profile of occupational therapy practice in Canada. Ottawa: Authors. Canadian Association of Occupational Therapists (2). (2002). Project Summary Report: Profile of Performance Expectations for Support Personnel in Occupational Therapy in Canada. Authors: Ottawa Chartered Society of Physiotherapy and College of Occupational Therapists. (2005). A National Framework for Support Worker Education and Development. London, England: Authors. Support Personnel in Occupational Therapy: Background Paper 22

Fine, S & Cronshaw S. (1999). Functional Job Analysis: A foundation for human resource management. Erlbaum: Mahwah, New Jersey Fine, S., Harvey, R., & Cronshaw, S. (2004). FJA strategies for addressing O*NET limitations in a post-dot environment. In Fleishman, E. A, (Chair), Things, Data, and People: Fifty years of a seminal theory. Symposium presented at the Annual Conference of the Society for Industrial and Organizational Psychology, Chicago. Ford, L., & McIntyre, G. (2004). Competency standards for occupational therapy assistants: Outline of the development process and applications. Frank, J. R. (2005). The CanMEDS 2005 physician competency framework: Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada. McNamara, C. (2002). Adapted from the Field Guide to Leadership and Supervision. Authenticity Consulting. Available: http://www.managementhelp.org/staffing/specify/job_nlyz/job_nlyz.htm OT Australia. (2005). Position Statement: Occupational Therapy Assistants. Authors. Available: http://www.ausot.com.au Ontario Ministry of Training, Colleges and Universities. (2006). Occupational Therapist Assistant/Physiotherapist Assistant Program Standard Review. Toronto: Authors Raymond, M. (2002). A practical guide to practice analysis for credentialing examinations. Educational Measurement, Issues and Practice, 21, 13 pages. The College of Occupational Therapists. (2005). Support Worker Education and Development: Learning opportunities. London: Authors The Chartered Society of Physiotherapy & The College of Occupational Therapists. (2005). A National Framework for Support Worker Education and Development. London:Authors, UK Sector Skills Council for Health. (2004). Skills for Health: National Occupational Standards. Accessed October 11, 2005. Available: http://www.skillsforhealth.org.uk/index.php Whiddett, S., & Hollyforde, S. (1999). The Competencies Handbook. Institute of Personnel and Development. London, England. Support Personnel in Occupational Therapy: Background Paper 23

Appendix 1. List of Occupational Therapy Support Personnel Education Programs in Canada Support Personnel in Occupational Therapy: Background Paper 24

Support Personnel in Occupational Therapy: Background Paper 25