Building OT Capacity
The Partnering for Change model of service requires occupational therapists (OTs) to deliver school-based services to children in a different way. Rather than services based on a direct, one-to-one intervention model targeting motor impairment, services are based on a population-based, health promotion, response to intervention model. This is a significant shift in practice for many OTs.
As a result, a comprehensive educational and mentorship program was developed by the research team and expert clinicians and was provided to the P4C therapists. The P4C OTs received extensive training and support, as reported in Occupational Therapist Training in the Research Study.
Prior to participating in the training, all OTs were asked to complete a questionnaire entitled: Partnering for Change Occupational Therapist Questionnaire: Exploring Occupational Therapist Skills, Knowledge and Beliefs. The questionnaire included content about knowledge, beliefs about the model, and skills grouped according to whom the skill assists: children, parents or educators.
The questionnaire was completed with the OTs at three time points: in the fall of 2013, prior to the OTs participating in training and service provision (T1), in the spring of 2014, at the end of the first year of service provision (T2) and in the spring of 2015, at the end of the second year of service provision (T3).
Some OT staffing changes occurred during the study as a result of OTs changing employment or requiring maternity and health leaves. As a result, 22 different occupational therapists delivered the P4C service during the two-year study. All of the 22 P4C OTs completed a T1 and T2 questionnaire. Ten OTs delivered the service for one year; either in Year 1 or Year 2, and therefore completed only pre- and post-questionnaires. Twelve OTs delivered the P4C service for parts of both years of the study. This group completed the OT Knowledge, Skills and Beliefs questionnaire at three time points. The results are shown in Figure 1
OT Knowledge, Skills and Beliefs Questionnaire
There was a statistically significant change noted between Time 1 and Time 2 in all categories of the questionnaire, with the exception of beliefs. This means that the OTs increased their knowledge and skills in all three content areas, in the first year of service provision. This change is likely attributable to the extensive mentorship support offered to the therapists.
Figure 2 shows the mean score increased for all categories on the questionnaire.
OT Knowledge, Skills and Beliefs Questionnaire
As shown in Figure 2, the OTs entered the study with a strong belief in the value of a collaborative, tiered, educationally compatible model of school-based occupational therapy. This is illustrated by the beliefs mean score being the highest of all domains measured on the OT Knowledge, Skills and Beliefs Questionnaire. The high beliefs score at Time 1 may be attributable to the process used to select OTs to participate. The service provider organizations that employed the OTs were provided with six true/false questions to share with OTs interested in delivering the P4C model. The questions asked about coordination difficulties, OTs’ role in schools and best practices and were to be used to screen interested candidates. It is likely that the OTs who volunteered to deliver the P4C model did so as a result of a belief in the value of this type of population based approach to school based occupational therapy service.
Although Figure 2 shows a steeper learning curve within the first year, the learning continued to increase in the second year and did not plateau. This suggests that OTs continue to require support in the second year to gain additional knowledge and the necessary skills needed to facilitate this significant shift in practice.
Responses provided by the OTs support that claim. Although the OTs rated the mentorship and resources provided highly, it was noted to be essential that this support be continued.
OTs completed questionnaires at the end of the second year to evaluate the support and mentorship that they received from the team. Fourteen OTs responded to the evaluation survey. Mean scores on a seven-point scale, with seven as the highest score, were:
- 6.0: Online learning module
- 6.6: Training workshops
- 6.4: Mentorship meetings
- 6.6: Email/phone and Q & A with mentor
The OTs also identified other supports they valued including:
- Open communication with members of the P4C research team, including the OT Mentor
- Provision of resources on USB key
- Resource sharing with colleagues at meetings
- Online materials to share with parents, videos etc.
The OTs provided suggestions for the future:
- Continue to require completion of the modules
- Offer training workshops, ongoing mentorship, opportunities for interagency collaboration and peer mentorship
- Provide opportunities for shadowing other OTs
- Allow time to prepare prior to start of school year
While the OTs valued the support received, they also identified that the shift in practice was difficult to make and that an on-site visit from the mentor would be very helpful. The continued learning, shown on Figure 2, supports this.
At the end of Year 2, all of the OTs were also asked to write “pearls of wisdom” for: Future P4C OTs, Managers and Funders of the P4C service, and the P4C Research Team. The need for continued support was repeated in the “pearls of wisdom” offered to managers and funders, and the research team: “Continue online modules for learning” and “Monthly meetings for mentorship are critical for ongoing learning, problem-solving situations, sharing resources and supporting the team.”
Messages to the research team also reinforced the need for continued support: “Mentorship from the team has been invaluable. Future OTs would definitely benefit from having direct or indirect access to your guidance and support.” Monthly bulletin/newsletter teleconferences, and/or use of webinars were also recommended.
Upon review of all of the evidence obtained during the two-year study, the following preparation is recommended for implementation of the P4C model of service in future:
Recommendations for Training OTs to Deliver the P4C Model of Service
|Identification of Occupational Therapists (OTs)||It is ideal to screen OTs to gauge their interest in and compatibility with the type of services offered in the P4C model|
|Completion of P4C modules||
P4C OTs should complete all P4C modules prior to OT starting at a P4C school.
The modules were licensed to the Ministry of Health and Long-Term Care (MOHLTC) for use during the P4C research project, with the licensing agreement expiring March 31, 2015. Additional copies must be purchased to meet copyright and licensing agreements.
New modules and updated content are expected to be available in January 2016.
|Attendance at a P4C Training Workshop||P4C OTs should complete a full day training workshop prior to starting to deliver the P4C service.|
|Shadow an experienced P4C OT||It is recommended that all new P4C OTs spend a day shadowing a P4C OT with experience.|
|Offer monthly mentorship meetings for all P4C OTs||It is essential that P4C OTs participate in monthly mentorship meetings during at least the 1st year of providing the P4C service to enable problem solving and peer support.
The monthly meeting should be led by an OT experienced in delivering the P4C model of service. This is necessary to successfully implement a new and very different model of service.
|Offer mentorship as needed for individual support.||It is essential that individual OTs have access to an experienced P4C OT who is available to provide ongoing support for new and existing P4C OTs. It is recommended that the mentor is available: for chart reviews; to provide support by telephone, email or in person meetings; and to visit a school as needed to support the P4C OT.|
|Ensure opportunity for P4C OT self-reflection.||It is recommended that new and existing P4C OTs reflect on their ability to deliver the P4C Model of service as intended and to consider how they are achieving the goals of the model.|
Lastly, the P4C OTs also reflected on their ability to achieve the P4C goals in each of their schools. At the end of each school year, in Year 1 and Year 2, the OTs rated how well they were able to achieve the P4C goals in each of their schools. The OTs did not identify their school but were asked to rate goal attainment, on a 10-point scale (with 10 being the highest score), for each P4C school to which they were assigned.
Goal achievement increased in the second year.
OTs' Ratings of P4C Goal Attainment: Mean Scores
|Goal achievement||Year 1||Year 2||Year 2 Range||Mode|
|Year 1 N=39/40; Year 2 N=31/40|
|Facilitate earlier identification of children with DCD.||6.4||6.8||2–10||9|
|Build capacity of teachers to understand and manage the needs of these children.||6.4||7.0||3–9||8|
|Build capacity of parents to understand and manage the needs of these children.||5.1||5.4||2–10||3|
|Improve children’s ability to successfully participate in school.||6.8||7.7||4–10||8|
|Improve children’s ability to successfully participate at home.||4.5||5.7||1–10||7|
|Facilitate self and family management in order to prevent secondary consequences.||4.8||6.0||3–10||8|
The result of the therapists’ self-reflection of goal attainment shows:
- OTs felt they were most effective in supporting the children’s ability to participate more successfully and in building the capacity of the educators to support the children.
- There was a great deal of variation across the schools in the degree of perceived goal achievement. The factors that influence variation warrant further investigation in subsequent studies.
- Reaching parents continues to be a challenge within a school-based practice model. This is consistent with the comments from some parents that they would have liked increased opportunity to communicate with the OT.