Utilizing Therapist Assistants in Pediatric Settings in British Columbia July 2007 This Power Point developed utilizing the resources and references from the report “Researching the Role of Rehabilitation Assistants in Paediatric Settings.” The report in its entirety can be found at

Introduction – Purpose of Project To explore if there is a role for therapist assistants in pediatric rehabilitation. This was attempted by: To explore if there is a role for therapist assistants in pediatric rehabilitation. This was attempted by: –Investigating existing utilization rates via a survey sent to public agencies in BC providing pediatric rehabilitation –A literature review –A comparison of provincial, national, and U.S. regulatory body and professional association (OT, PT, SLP) guidelines on the use of support personnel –Stakeholder discussion via phone interviews and a focus group –Examination of existing therapist assistant education programs in British Columbia

Current Use of Therapist Assistants in BC Pediatric Settings Current Use of therapist assistants in pediatric settings: Canadian literature suggests prevalence rate of about 5%, while United States literature demonstrates prevalence of about 20% Current Use of therapist assistants in pediatric settings: Canadian literature suggests prevalence rate of about 5%, while United States literature demonstrates prevalence of about 20% Reported benefits in the literature: Reported benefits in the literature: -Increase in number of patients able to access service -More cost-effective service delivery -Therapists in rural/remote settings report less isolation when working with assistants -Therapists able to spend more time performing more specialized work Reported disadvantages: Reported disadvantages: - increased time initially to train assistants and set-up a supervision plan - assistants create an increased distance between the client and the practitioner - liability concerns - concerns regarding roles and responsibilities of support personnel

Literature Review Patient satisfaction remains high when receiving services from a rehabilitation assistant (study involving adult patients) Patient satisfaction remains high when receiving services from a rehabilitation assistant (study involving adult patients) Most frequently utilized by SLP’s and OT’s when working with school-aged children Most frequently utilized by SLP’s and OT’s when working with school-aged children U.S. training is more profession specific U.S. training is more profession specific National education standards and program accreditation processes well entrenched in the U.S. system. Canada making progress in this area but lagging well behind the U.S. National education standards and program accreditation processes well entrenched in the U.S. system. Canada making progress in this area but lagging well behind the U.S.

Survey of BC Pediatric Agencies 72 agencies were sent the survey, 38 responded. 11 of these agencies currently utilize some type of support personnel 72 agencies were sent the survey, 38 responded. 11 of these agencies currently utilize some type of support personnel –Most common activities performed: -Preparation and clean-up of treatment areas -Directly assisting with active therapy -Running group classes or activities -Administrative duties such as scheduling Reasons given by those not currently utilizing therapist assistants: Reasons given by those not currently utilizing therapist assistants: -Funding limitations -Would rather hire more therapists -Uncertain of the role of TA’s in pediatric settings

Stakeholder discussion Included pediatric therapists (PT, OT, SLP), IDP representatives, professional regulatory body and association representatives, CDC executive directors, education institution representatives, MCFD representation, Aboriginal community representation, families utilizing therapy services, therapist assistants Included pediatric therapists (PT, OT, SLP), IDP representatives, professional regulatory body and association representatives, CDC executive directors, education institution representatives, MCFD representation, Aboriginal community representation, families utilizing therapy services, therapist assistants Proposed benefits: -increased access to service (larger caseloads, group therapy, more appropriate use of therapist’s skill level, cost- effective) Proposed benefits: -increased access to service (larger caseloads, group therapy, more appropriate use of therapist’s skill level, cost- effective) Barriers: - lack of knowledge regarding how to effectively utilize TA’s, funding, lack of supervising therapists Barriers: - lack of knowledge regarding how to effectively utilize TA’s, funding, lack of supervising therapists Concerns: - TA education levels, inappropriate use, training time, increased distance between therapist and child, less ‘hands-on’ treatment time for therapists, lack of regulation of TA’s, lack of SLPA Concerns: - TA education levels, inappropriate use, training time, increased distance between therapist and child, less ‘hands-on’ treatment time for therapists, lack of regulation of TA’s, lack of SLPA

Report Recommendations 1. Recommend TA’s join support personnel membership category of a therapy professional association 2. Supervision guidelines stipulating a therapist may supervise a maximum of 2 TA’s at once, and must re-evaluate all children being followed by a TA a minimum of every 3 months 3. Establish tasks and activities specific to pediatrics in accordance with regulatory body guidelines 4. Develop a document/workshop on strategies to effectively incorporate therapist assistants in pediatric rehabilitation 5. Develop strategies with aboriginal communities to support the use of therapist assistants 6. Strengthen communication and collaboration between BC therapy assistant education programs and agencies delivering pediatric rehabilitation services

Initiatives as a result of the report Three additional reports were created as a result of the initial project. All can be found under the ‘Projects and Initiatives’ link, ‘Paediatric Therapy Consultant Updates’ section of the website The additional reports: Three additional reports were created as a result of the initial project. All can be found under the ‘Projects and Initiatives’ link, ‘Paediatric Therapy Consultant Updates’ section of the website The additional reports:  Sample Tasks and Activities Performed by Therapist Assistants in Pediatric Rehabilitation Settings  Frequently Asked Questions Regarding the Use of Therapy Assistants in Pediatric Settings  An Employer’s Guide to Hiring a Therapist Assistant

Samples of Therapist Assistant Use in Pediatric Settings Group programs The therapist assistant can be a valuable resource in group therapy sessions. Utilizing a TA can help the therapist handle a larger class size (thus allowing greater access to services), or when appropriate the TA can run a class on their own (participants selected by the supervising therapist, program developed by supervising therapist). The therapist assistant can be a valuable resource in group therapy sessions. Utilizing a TA can help the therapist handle a larger class size (thus allowing greater access to services), or when appropriate the TA can run a class on their own (participants selected by the supervising therapist, program developed by supervising therapist). Children with ‘mild’ developmental delay can often effectively receive services via group programs. These children often receive little to no therapy services at all due to therapist’s large caseloads and service prioritizing.

Samples of Therapist Assistant Use in Pediatric Settings Gross Motor Group: For: Children screened by therapist who have mild gross motor developmental delay (e.g. – Developmental Co-ordination Disorder). What: Therapist develops parameters for therapist assistant to follow, and therapist and TA develop series of stations or activities to take children through. Fine Motor Group: For: Children screened by therapist who have mild fine motor developmental delay (e.g.- poor buttoning/dressing skills). What: Therapist develops parameters for TA, and activities are developed by therapist and/or TA for children to participate in.

Samples of Therapist Assistant Use in Pediatrics Communication: For: Children screened by SLP who have been determined to have a mild delay in their speech skills. What: Supervising SLP and SLPA develop activities for group to perform that helps to develop the children’s communication skills

Samples of TA Use in Pediatrics The Extra Set of Hands When working with children with significant mobility and positioning issues, the extra set of hands a therapist assistant can provide can help more effective delivery of the service. This can help ease the physical strain on the therapist performing the treatment, and may help the therapist perform techniques they would otherwise be unable to do if providing the service on their own. Due to therapist assistants receiving training in anatomy, medical terminology, and positioning techniques it would be much more efficient and safe having a TA assist rather than an untrained adult.

Samples of TA Use in Pediatrics One-to-one therapy with medically stable children not requiring a great deal of clinical judgment to treat The child with joint contractures due to increased tone can receive passive ROM and stretching from a TA. The initial assessment and intervention plan are developed by the supervising therapist, and then the TA can carry out the plan. This will usually allow for a greater frequency of service for the child, and the TA can report back to the supervising therapist any change in patient status that would require a re-evaluation and modification of the intervention plan.

Sample of TA Use in Pediatrics The Therapist’s Personal Assistant How much of your work day as a therapist is spent setting up equipment, cleaning treatment devices/toys, preparing gear for home visits, contacting funding sources, and confirming appointments? A therapist assistant can perform all of these activities, so therapists can focus on delivering therapy. Freeing up therapists for more specialized work would likely contribute to a more manageable workload and improved job satisfaction.

Strategies to Incorporate TA’s - Volunteer to take a TA student for their clinical practicum - TA education programs in BC are always looking for new practicum opportunities for their students. Currently have difficulty fulfilling student requests for paediatric placements. Nice way for therapists and agencies to see how a TA can be utilized in a paediatric environment. Clinical coordinators at the schools are more than happy to meet with interested agencies and therapists, and do perform inservices on clinical supervision as well. - Verse yourself in the documents on regarding therapist assistants - Contact the respective professional regulatory body for any questions/concerns not addressed by resource materials

Strategies, cont’d Start utilization of a therapist assistant in a controlled, well-supervised environment (e.g. - therapy department of a CDC). This will allow for therapists to learn how to effective utilize the assistant, and provide appropriate supervision. As roles and responsibilities are clarified and understood, the use of the therapist assistant can be expanded. Start utilization of a therapist assistant in a controlled, well-supervised environment (e.g. - therapy department of a CDC). This will allow for therapists to learn how to effective utilize the assistant, and provide appropriate supervision. As roles and responsibilities are clarified and understood, the use of the therapist assistant can be expanded.