I! ‘ i 3 Mammy Michigan State a; Univ ersty 1% j- This is to certify that the thesis entitled AN IDENTIFICATION OF OCCUPATIONAL THERAPIST COMPETENCIES WITH IMPLICATIONS FOR LIFELONG EDUCATION presented by VIRGINIA KNOX WHITE has been accepted towards fulfillment of the requirements for PH. 0. degree in EDUCATION Ii Major professor 7 Date II“ ’3'— X0 0-7 639 F.” “fl‘ .' I # "w'vr . - PM «runner-wt“: LII/t .3 ‘ .4m.‘ ‘, :6“ \}|\\‘. ' .‘ imam-I. ' " Ili'. OVERDUE FINES: 25¢ per day per item RETURNING LIBRARY MATERIALS: Place In book return to rem charge from circulation reco: AN IDENTIFICATION OF OCCUPATIONAL THERAPIST COMPETENCIES WITH IMPLICATIONS FOR LIFELONG EDUCATION By Virginia K. White A DISSERTATION Submitted to Michigan State University in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of Administration and Higher Education 1980 ABSTRACT AN IDENTIFICATION OF OCCUPATIONAL THERAPIST COMPETENCIES WITH IMPLICATIONS FOR LIFELONG EDUCATION By Virginia K. White Purpose of the Study The purpose of this study was to determine the essential, supple- mentary and emerging competencies (skills and knowledge) needed by occupational therapists (OTs). The study focused on three major objectives: (l) to define the competencies needed by OTs; (2) to validate by obtaining consensus of members of the profession as to the essential. supplementary and emerging competencies needed by OTs; and (3) to derive an educational model for lifelong profes- sional development from the implications of the data analysis. Methodology for the Study A three phase methodology was used to attain the stated objec- tives for the study. Phase One consisted of identifying a list of competencies from a literature review. In Phase Two an OCCUPATIONAL THERAPISTS' COMPETENCY INVENTORY was designed and pilot tested by five American Occupational Therapy Association Fellows living in Michigan. The INVENTORY contained two parts: a list of competency statements (124) and a personal data section (16 demographic vari- ables). The Delphi procedure for obtaining opinions of a panel of experts was used in Phase Three to determine how essential panel- ists thought the competencies to be. Fellows of the American Virginia K. White Occupational Therapy Association, Curriculum Directors of programs for OTs and assistants, and a random sample of graduates within the last five years composed the panel. Opinions were obtained in two rounds, using two INVENTORIES: Round One response rate was 37% usable INVENTORIES (301), and Round Two, 76% (229). Feedback from Round One was given as means and frequency of responses in each of the five intervals of the Likert-type scale. Descriptive statistics included the semi-interquartile range, Leik Formula, Multivariate Analysis of Variance, Univariate F Test, Roy-Bargman Stepdown F Test and the mean, to report the findings. Conclusions of the Study The findings of the study supported the following conclusions: The EMERGING Competencies which were considered ESSENTIAL at entry level were in Direct Client Service (3), Occupational Therapy Theory (2), Indirect Client Service (8) and OTs in the Schools (3). Specifically, these were the following: applying OT to clients with or without disabilities; developingfunctionalliving programs with team members; applying purpose of adaptive devices to client's needs; distortion of occupation lifelong; use of occupation in health problems; building trusting relationships; team working; identifying community resources; applying OT theory in schools; analyzing behav- ioral theories; maintaining professionalism; initiating and directing one's professional growth; and articulating uniqueness of OT. The EMERGING ESSENTIAL Competencies did not represent technical changes in skills but reflected a response to social and political pressures. Virginia K. White Across all panelists the proportions of competencies that reached consensus as ESSENTIAL were 60%; SUPPLEMENTARY, 0%; and EMERGING, 28%. The two panelist groups viewed the competencies in the INVENTORY as a whole differently. Fellows and Curriculum Directors considered Direct Client Services, Life Tasks and Activities, Basic Human Sciences, Health-Illness-Health, OT Theory, and Human Development more essential. Recent Graduates considered EMERGING Competencies in Indirect Client Services and OT in the Schools more essential. Significant differences were found between competency scales and demographic variables of education, years in practice, work setting and work functions. This applied to the whole INVENTORY also. The Delphi procedure was useful in obtaining consensus of panel- ists. Scales with lowest consensus were mostly EMERGING ones having low scale means indicating less agreement on competencies ranked less essential. Implications of this study are for a dynamic lifelong profes- sional development model in which people move in and out of formal and nonformal learning experiences as best meets their personal and professional needs without regard for age or other stereotypic conceptions. © Copyright by VIRGINIA KNOX WHITE 1980 ACKNOWLEDGMENTS The completion of a doctoral study is the culmination of many years of formal and nonformal education. Although intrinsically the effort is a solitary one, it cannot be accomplished without "significant others" in one's home, work, and educational environments. To these special persons I offer a humble thanks and gratitude for each person's unique contribution. To my family - my husband, Syd, for his endless support, critiques, and inspiration; my sons and daughters, Jack and Gin, Ric and Betty, Judy and Jim, Suzanne, Nancy and Clarence, for their constant encourage- ment and reinforcement. To my Guidance Chairman, Dr. Lawrence Borosage, for his ability to stimulate creativity, inspire the pursuit of learning and give wise and frequent counsel in all phases of program planning and imple- mentation - guiding and reinforcing all steps in the doctoral process. To my Dissertation Chairperson, Dr. Norma Bobbitt, who patiently, kindly, and wisely helped me strive for excellence in the dissertation, giving hours of reading and conceptualization time. To my committee members: Dr. Howard Hickey, whose courses led to a commitment to enter the doctoral program; whose warmth and readiness to assist were always available. 11 Dr. Joe Papsidero who guided the struggle through an essen- tial part of the literature review and gave ongoing thoughtful comments and suggestions. Dr. Don Galvin, friend and supporter of occupational therapy; always willing to support professional goals and give wise suggestions. To Dr. Lawrence Lezotte who helped plan the research methodology, for his clear, straightforward grasp of the study and ability to reduce the complex to the practical. To Frank Jenkins, research consultant, who gave expert guidance through the data analysis process. To Margaret Beaver who labored long and skillfully in the typing of the dissertation, giving much needed suggestions whenever crises arose. Her skill and friendliness is not excelled. To the Michigan Occupational Therapy Association whose research grant contributed to the expenses of the study. And finally, to my pilot study members - the Fellows of AOTA who lived in Michigan - who gave time, knowledge and friendly advice in the survey methodology and procedures: Martha Moersch, Lyla Spel- bring, Libby Boles, Dean Tindall, and Dave Ethridge. Without the 229 respondents to the two INVENTORIES, there would have been no data - to them a special thanks for their time and thought. Figures 2 and 3 are reprinted with permission from the American Occupational Therapy Association. TABLE OF CONTENTS Page LIST OF TABLES ........................ LIST OF FIGURES ....................... CHAPTER 1. THE PROBLEM ................... 1 Introduction ...................... 1 Background ....................... 1 Statement of the Problem ................ 5 Research Questions ................... 6 Significance of the Study ................ 7 Purpose of the Study .................. 8 Basic Assumptions for the Study ............. 8 Delimitations of the Study ............... 9 Definition of Terms ................... lO Footnotes ........................ 12 CHAPTER II. REVIEW OF LITERATURE .............. 13 Competency-based Education ............... 13 Occupational Therapy Literature ............. 27 AOTA Essentials of an Accredited Educational Program for the Occupational Therapist ..... 27 Occupational Therapy Literature Related to Philosophy, Principles and Theory ........ 32 Summary of Occupational Therapy Literature Related to Philosophy, Principles and Theory 41 General Competencies Within the AOTA Essentials . . 43 Literature References to Educational Areas ..... 44 Literature Related to Emerging Competencies 47 Opinions of Leaders in Occupational Therapy from the Representative Assembly Session in November, 1978 ................ 55 Implications of Social Policy Legislation ........ 60 PL 93-112: The Rehabilitation Act of 1973, Amendments of 1978 ............... 61 PL 94-142: Education of All Handicapped Children Act of 1975 .............. 64 PL 93-222: Health Maintenance Organization Act of 1973 ................... 67 PL 93-641: National Health Planning and Resources Development Act of 1974 ........ 71 PL 92-603: Social Security Amendments of 1972 . . . 74 iv TABLE OF CONTENTS (Continued) CHAPTER 11. REVIEW OF LITERATURE (Continued) Research Methodology .................. The Delphi Procedure ................ Survey Methodology ................. Footnotes ........................ CHAPTER III. METHODOLOGY AND DATA COLLECTION ........ Type of Study ...................... Objectives ....................... Research Question #1 ................ Research Question #2 ................ Research Question #3 ................ Research Question #4 ................ Research Question #5 ................ Research Question #6 ................ Research Question #7 ................ Design of the Study ................... Population and Sample .................. Data Collection ..................... Data Analysis ...................... Footnotes ........................ CHAPTER IV. RESEARCH FINDINGS ................ Background of Sample .................. Analysis of Round One or Round Two Data ......... Data Analysis ...................... Scale Formation .................. Statistical Procedures ............... Research Question #1 .................. Operational Definition ............... Research Findings ................. Hypotheses Summary ................. Research Question #2 .................. Operational Definition ............... Research Findings ................. Research Question #3 .................. Operational Definition ............... Research Findings ................. Research Question #4 .................. Research Findings ................. Hypotheses Summary ................. Research Question #5 .................. Operational Definition ............... Research Findings ................. Hypotheses Summary ................. Page 79 82 85 101 103 107 110 111 112 114 114 117 118 118 119 119 124 124 124 128 128 TABLE OF CONTENTS (Continued) Page CHAPTER IV. RESEARCH FINDINGS (Continued) Research Question #6 .................. 142 Operational Definition ............... 142 Research Findings ................. 144 Hypotheses Summary of Professional Degrees ..... 146 Research Findings ................. 147 Hypotheses Summary of Years of Practice ...... 152 Research Findings ................. 152 Hypotheses Summary of Work Setting ......... 155 Research Findings ................. 156 Hypotheses Summary of Work Function ........ 159 Research Question #7 .................. 162 Research Findings ................. 162 Convergence to Consensus Between Groups ......... 162 Summary of Research Findings .............. 170 Footnote ........................ 170 CHAPTER V. SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS ..................... 171' Summary of Findings ................... 180 Discussion and Conclusions ............... 193 Essential Competencies ............... 193 Supplementary Competencies ............. 193 Emerging Competencies ............... 194 Degree of Consensus ................ 196 Degree of Consensus Between Groups ......... 196 Differences Between Subpopulations ......... 197 Differences Between Subpopulations as Total Groups . 198 Change to Nontraditional Settings ......... 198 Present Employment ................. I99 Participation in Continuing Education ....... 199 Discussion ....................... 199 Implications ...................... 202 Model of Lifelong Professional Development ....... 207 Recomnendati ons ..................... 221 To the Profession of Occupational Therapy ..... 221 To the Educators of Occupational Therapists . . . . 223 To Future Research in the Area of OTs' Competencies ................. . 223 Footnotes ........................ 226 APPENDICES .......................... 228 Appendix A. Sources of Competencies .......... 228 Appendix B. Tables of Variables ............ 233 Appendix C- Participant Correspondence ......... 237 Appendix D. Sample of Round Two Inventory ....... 244 BIBLIOGRAPHY ......................... 258 vi Table boom 01 10 ll 12 I3 14 15 16 LIST OF TABLES Responses to the INVENTORY for Rounds One and Two . . . INVENTORY timetable for obtaining and analyzing data, , Summary of characteristics of panelists ........ Homogeneity of competencies for existing and emerging competency scales ................... Competencies considered ESSENTIAL by panelists Competencies considered SUPPLEMENTARY by panelists Competencies considered USEFUL BUT NOT ESSENTIAL by panelists ....................... EMERGING Competencies: Number within scales ranked as ESSENTIAL or SUPPLEMENTARY ............. Summary of variables reaching consensus in each range of convergence .................... Summary of frequency of variables reaching consensus within ranges of consensus .............. Summary of all competencies by number, proportion and consensus (.77) .................... Percentage of ESSENTIAL and SUPPLEMENTARY competencies in Existing and Emerging scales reaching consensus of .77 ........................ Summary of test differences for each round, subpopula- tion and scale .................... Convergence to consensus ............... Means of scales .................... Change of panelist groups on scale means between rounds ........................ vii Ease 105 106 113 116 120 125 127 129 131 131 133 133 160 166 168 167 LIST OF TABLES (Continued) Table Page 17 Scales identified by variable number and essen- tiality ........................ 178 18 Rank order of essentiality of scales by demographic group ......................... 191 Appendix B B-l Variables, convergence to consensus, semi-inter- quartile range, and frequencies for Rounds One and Two .......................... 233 B-2 Listing of inventory competency statement with corresponding variable number ............. 236 viii LIST OF FIGURES Figure Page 1 Curriculum development model for proficiency education ...................... 28 2 The basis of occupational therapy - the impact of occupation on the human being ............ 34 3 The components of occupational therapy ....... 36 4 Role and functions of occupational therapist and occupational therapy assistant at entry level competency ..................... 4O 5 Summary of data analysis .............. 109 6 Convergence to consensus on emerging and existing scales by all panelists ............... 164 7 Comparison of responses to competency statements in Rounds One and Two using histograms ....... 175 8 Statistical tests used to determine differences between groups on all scales ............ 179 9 Content of educational experiences and goals of lifelong education ................. 209 10 Supplementary Competencies: Indirect Client Service categories, first and second choices for learning ...................... 213 11 A dynamic model of lifelong professional development ..................... 215 ix Chapter 1 THE PROBLEM Introduction This study is concerned with the educational preparation of occupational therapists (OTs) for entry into the profession. As a member of the health professions, OTs have found it necessary to adapt to changes in social policy that affect health care delivery and the lives of consumers of professional services. To do this, therapists have discovered a need for new competencies not acquired in basic professional education. Educational programs which prepare OTs for entry into the profession of therapy need to be aware of these competencies and their relative importance. The findings from this study will help the profession of occupational therapy make decisions about changing entry-level essential standards. The next section on the background for this study will enlarge upon these issues and establish the need for investigation focusing on emerging competencies of OTs. Background The decade of the seventies was a period of great change in health care delivery, primarily as a result of social policy legisla- tion both at the federal and state levels of government. "Nineteen hundred and eighty marks the time of new beginnings for our nation. I 2 The nation is undergoing a major transition in health care policy - a shift from costly disease treatment to a prevention/promotion policy."1 As social policy shifted from a disease-oriented medical model to one of prevention, the maintenance of health presented a new location for practice of health professionals - the community and the client's home. The increase in the life span with its accom- panying chronic health problems among the elderly has contributed to the challenges faced by the health practitioners and society in general, to help maintain satisfactory quality of life for adults in later years of life. Additional emphasis on quality standards for health care delivery, on accountability for services rendered and cost-benefit analysis all have had implications for providers of health care. Throughout the history of the profession, occupational therapy has been affected by social policy changes and significant happenings within the health sector of society. Careful consideration and weigh- ing of issues followed sensitization to changing circumstances before actual adaptations or shifts in practice occurred. For example, the shell-shocked veterans of World War I who were without an occu- pation, led to the psychosocial beginnings of occupational therapy -- the need to be doing something purposeful. The amputees and spinal cord injuries of World War II prompted a stronger emphasis on physical disabilities in occupational therapy. Tuberculosis and polio led to the identification of new techniques and procedures to serve these chronic patients. During the 1960's and 1970's, society's emphasis on mental retardation and other developmental disabilities resulted in occupational therapists (OTs) working in the institutions for the 3 mentally retarded and the school systems in increasing numbers. The 1977 member survey by the American Occupational Therapy Association (AOTA) for Michigan OTs indicated that 29% of the OTs in the state were employed in schools, the single largest location of practice. As OTs expand their employment to the community and beyond the hospitals and rehabilitation centers to working with new populations such as the severely multiply handicapped and retarded, a need for new knowledge and skill has arisen. These educational implications have been recognized by the occupational therapy profession. The American Occupational Therapy Association's Long Range Plan (1978)2 contains a goal which speaks to the relevance of this study. It is the following: Goal #3: To facilitate and support an educational system for occupational therapy which responds to current needs, anticipates, plans for, and accommodates to change. This Plan also includes critical problems relative to the educational preparation of OTs, one of which is that the current "Essentials" (upon which curricula are based) offer no clear criteria relative to the academic competence of occupational therapy educators, nor to the clinical competence of students' field work supervisors, which thus varies from program to program. Although not directly related to the competency of students, this does identify a problem within the occupational therapy educational programs which has an influence on therapist's education. The Plan states, in regard to education of OTs: "It is evident, therefore, that a dichotomy exists between 'what is' and 'what should be', and thus, by definition, there is a problem." 4 The issue of assuring competency through recertification is presently being addressed by the Division of Certification of AOTA. During 1976-78 the Examination Development Project from that Division engaged in a study to delineate the role of entry-level occupational therapy personnel. This information was used as a basis for develop- ing questions for competency examination. Because of the limited scope of the roles of OTs selected for this study, no attention was given to emerging settings and foci of practice. The profession of occupational therapy, because of the shift to a prevention model of health care, legislative demands for account- ability and precision of quality care, is studying and discussing nationally issues affecting current practice and future directions for the profession. Among these are entry into the profession at the graduate level only, the therapist as technician or professional, and the direct service role, consisting of one-to-one treatment, versus the indirect, in which the therapist consults with another professional or an assistant who delivers client services. This last issue was responded to in the report of the Ad hoc Committee on Educational Standards Review, submitted to the Representative Assembly of the AOTA in April, 1980. Addressing the philOSOphical issue of entry-level role functions, respondents to the committee's survey endorsed the clinical practice role function for the OTR but rejected the role function of consulting, administration and supervi- sion, community health care planning and research. They stated that these four functions necessitate either graduate level education or job experience. 5 At the AOTA national conference, April, 1980, the issue of entry- level standards was referred to the Ad hoc Inter-Commission Committee of AOTA to be incorporated in their effort to coordinate the selec- tion of the most appropriate role delineation for occupational therapy for presentation to the Representative Assembly for approval in 1981. The Accreditation Committee, presently concerned with the issue of post-baccalaureate entry into the profession, has indicated interest in the results of this study for their decision-making. Since the Representative Assembly committees will be studying the entire entry- level Essentials Review over the next few years, the data from this study can be useful information for their deliberations. A related issue which has a direct bearing on the movement of practice to the community is the payment of occupational therapy services by third party payors such as Medicare, for services provided in the community. This is one example of the influence of social policy legislation on the professional practice of OTs. Statement of the Problem Because the medical model is changing from disease oriented to one of prevention, and social policy legislation has mandated new health services and accountability requirements, new competencies for occupational therapy practice have emerged. This study has addressed the first step in curricular change: identification of competencies needed by OTs for practice. The problem for study was to identify those emerging competencies essential to the practice of OTs at this time. Research Questions The following questions arise from the problem for study: I. What are the essential competencies needed for entry into the profession of occupational therapy? What supplementary competencies may be needed for entry into the profession of occupational therapy? What are the emerging competencies which OTs need to practice within changing social policies and in settings other than the traditional hospitals and rehabilitation centers, such as schools, homes, residential care facilities, health agencies, and other community locations? What degree of consensus is there across members of the profession regarding the essential, supplementary and emerging competencies? To what degree do Group One (Fellows and Curriculum Directors) and Group Two (Recent Graduates) agree regarding how essential the various competencies are? Do significant differences exist between the competency scales? 7 7. Would therapists take a job in a non- traditional setting? If so, for what reasons? Significance of the Study As health care changes from a disease-oriented medical model to one emphasizing prevention, work settings for OTs have shifted from the hospital to the community - to homes, schools, and health agencies. The need for professional accountability, cost-benefit analysis and quality assurance measures have added dimensions to work roles for which therapists are often not prepared. Issues have arisen for therapists such as how to decide where to obtain the neces- sary competencies demanded in their work: through graduate eduCation, workshops or short courses, or inservice conducted by employers. University programs in occupational therapy, although aware that more skills and knowledge need to be taught, have difficulty setting priorities among content materials and finding time to teach present courses. The fact is that occupational therapy educational programs are basing their curricula on the AOTA Essentials of an Accredited Edu- cational Program for the OT which were derived from the roles of OTs in the traditional model of practice which was hospital located and illness-oriented. Emerging roles require additional competencies. Also, present OTs need a lifelong educational plan to assist them in maintaining professional competency. The profession nationally (AOTA) recognizes the need for the Essentials, for preparing OTs to meet the new Quality Review Standards, 8 and for maintaining certification of competency of practicing therapists. Since this study has addressed the perceptions of occupational ther- apists regarding present day practice competencies, it will contribute to the information needed to resolve some of the issues facing the profession in the 1980's. The lifelong education model derived from the identification of competencies can also be applied as a process to other health professions. Purpose of the Study It is the intent of this study to determine the essential, supple- mentary and emerging competencies needed by OTs, as perceived by a panel of experts, and to propose an educational model that will describe a process for acquiring and maintaining lifelong professional competency. The following objectives will be accomplished by this study: 1. To define the competencies needed by occupational therapists. 2. To validate by obtaining consensus of members of the profession as to the ESSENTIAL, SUPPLEMENTARY, and EMERGING competencies needed by occupational therapists. 3. To derive an educational model for lifelong professional development from the data analysis. Basic Assumptions for the Study The following assumptions were made in order to accomplish the objectives of this study: I. That change is inevitable, and that the profession of occupational therapy will gradually adapt to changes in social policy related to health, adjusting its practice and educational preparation accordingly. That the members of the profession - both leaders and new practitioners - are sufficiently informed to respond to statements of competency of occupational therapists at the entry-level into the profession. That the occupational therapists will engage in lifelong education, either formal or non-formal, as is true of most adult pro- fessionals. That since the certification and recertifi- cation process within AOTA is using competencies as a basis for examination and skill assessments, and an AOTA study of Occupational Therapy in the Schools has defined competencies for that locus of practice, it was assumed that competency-based education needed to be reviewed for this study. Delimitations of the Study Selected occupational therapists served as respondents to the two INVENTORIES. The essentiality of each competency was 10 measured only by the perceptions of these occupational therapists. It remains for additional studies to determine the perceptions of others with whom therapists have significant interaction. Survey methodology and the Delphi procedure have inherent limita- tions, one of which is obtaining responses from a long questionnaire. Although the INVENTORIES in this study were long, an effort was made to restrict length by stating competencies in general terms. It was recognized that the Delphi procedure was also limiting, but was con- sidered to be the best research method for this study. Definition of Terms Occupational Therapy is the art and science of directing man's participation in selecting tasks to restore, reinforce and enhance performance, facilitate learning of those skills and functions essential for adaptation and productivity, diminish or correct pathology, and to promote and maintain health. Its fundamental concern is the capacity, throughout the life span, to perform with satisfaction to self and others those tasks and roles essential to produgtive living and to the mastery of self and the environment. Occupational Therapist, Registered, is a member of the occupa- tional therapy profession who is listed on the roster of AOTA as certified to practice as a registered occupational therapist. Competency-based Education is a system of education based on the specification of what constitutes competency in a given field. AOTA Essentials are the Essentials of an Accredited Educational Program for the Occupational Therapists, established and adopted by the American Occupational Therapy Association, Inc., Council on Education, October, 1972, in collaboration with the American Medical Association, Council on Medical Education; adopted by the AMA House of Delegates, June, 973. 11 Operational Definitions Competencies are defined as skills, knowledge, attitudes and their usefulness to the practice of occupational therapy. Competencies have been described as generic knowledge, skills, traits, self-schema or motives of a person that are causally related to effective behavior referenced to external performance criteria.5 Essential Competencies are those which the panel of experts says are essential or aboslutely essential (on the INVENTORY rating scale). Supplementarprompetencies are those which the panel of experts says are minimally or probably essential (on the INVENTORY rating scale). EmergingCompetencies are those competencies derived from a review of occupational therapy and other relevant literature, social policy legislation, and which are not now a part of the AOTA Essentials. The operational definition provides the criteria for determining how essential the panelists consider the emerging competencies. It is all competencies ranked as useful but not essential at entry level to abso- lutely essential. Delphi Procedure is an effort to produce convergence of group consensus through a series of questionnaires dealing with future-oriented questions. Scales are combined indices or variables (competencies, in this study) which are closely related to each other. There are two different scales in this study: 7the Existing Com- petencies and the Emerging Competencies. Chapter I has introduced the problem of the study including the background information and statement of the problem. Research ques- tions-arising from the intent of study were given as were the signifi- cance, basic assumptions, delimitations and definitions of terms. Chapter II will contain the review of the literature relevant to this study. 12 Footnotes 1Canton, James. "Health Policy at the Crossroads," from Health Forecast, Vol. 1, No. l, 1980. 2American Occupational Therapy Association's Long Range Plan, Feburary 22, 1978. 3Occupational Therapy: Its Definition and Function. American Journal of Occupational Therapy, XXVI, 1972. 4May, Bella J. "Evaluation in a CBE System," Physical Therapy, LVII, (January 1977), p. 28. 5Klemp, George 0., in Definingyand Measuring_Competence, edited by Pottinger and Goldsmith. California: Jossey-Bass Publishing Company, 1979, p. 42. 6Young, Wanda. "Family Studies Program Development at the College Level: A Delphi Study," unpublished dissertation, Michigan State University, 1977. 7Warwick, Donald P., and Lininger, Charles. The Sample Survey: Theory and Practice. New York: McGraw-Hill, 1975. Chapter 11 REVIEW OF LITERATURE In this chapter the review of literature will be divided into four parts: 1. Competency-based Education (CBE) 2. Occupational Therapy literature regarding identification of competencies 3. Social Policy Legislation 4. Research Methodology Delphi Procedure Survey Methodology Cpmpetency-based Education Since this study dealt with competencies required for profes- sional practice, as a first step in curricular change and development, the broad area of competency-based education needed to be considered. In medical and allied health education various approaches have been used to evaluate readiness for professional practice: accredita- tion of education programs and credentialing of health professionals. Recently CBE has emerged as another alternative for assuring that graduates possess predetermined competence required for entry-level professional performance. Pottinger and Goldsmith8 state that al- though there may not be total agreement about the meaning of 13 l4 competency, some consensus emerges about the following important aspects of the concept: 1. That it is desirable. That it can be taught. That it can be measured. #00“) That it can have a major impact on improving both the quality of education and professional service. CBE is a systematic approach to curricular design that enables the learner to progress step-by-step toward the achievement of the 9 competency. CBE can be perceived as a very broad concept that is used as the conceptual framework for a totalcurriculwn,or more nar- 10 The rowly as a framework for an individual unit of instruction. broad interpretation allows the learner to be self-directed in the selection of and obtaining of goals and objectives; the narrow frame- work identifies the competency or outcome of learning as well as the evaluation method prior to the learning experience so that the learning stratgies can be based on the performance objective. CBE is not defined in standard dictionaries. The word compe- tency has been interpreted to mean the "ability to do" in contrast to the more traditional emphasis on the "ability to demonstrate know- ledge."11 CBE is an educational approach having two primary charac- teristics: first, precise learning objectives defined in behavioral, assessable terms, and known to the learner and teacher alike. Compe- tencies are first identified as general goals, then stated as perfor- mance objectives which have a stated behavior to be changed, conditions for completing the learning effort and a standard by which the learners' 15 12 The second characteristic is account- performance will be judged. ability: the learner knows the learning expectation, accepts respon- sibility for doing the activity and expects to be held accountable for meeting the established conditions. Elam (1971)13 developed a list of essential elements of CBE programs: 1. Competencies are derived from the role of the practitioner, are specified in behavioral terms and are made public in advance. 2. Assessment criteria are competency based and specify expected levels of mastery and are made public. 3. Assessment of learners is based primarily on performance. 4. Learners' progress through the program depends on demonstrated competency. 5. The instructional program facilitates development and evaluation of competencies. It is through these elements that accountability in education is possible. The identification of responsibility which is account- ability has been dealt with extensively by Browder.14 He states that political, social and economic change pressures demand respon- siveness to perceived problems. Universities with diminishing student enrollments are receiving complaints from practitioners (former students) that they are not prepared for the real world. Through CBE universities can seek to achieve accountability to students by basing instruction on practice-based competencies. Browder states 16 further that the concept of accountability looks at task definition and how work to be done is stated. Traditionally the work has been implied or stated generally, sometimes in writing and sometimes not. The emerging pattern is the use of performance objectives within a CBE program. In the evaluation stages of instruction the fact that outcome variables have been determined in the planning phase and stated in measurable terms permits accurate evaluations of the learning outcome. Performance evaluation in CBE is done by means of criterion-referenced tests and other evaluation measures which base test items on criteria that have been determined in the performance objectives at the begin- ning of the course. Attainment of the predetermined standard of performance is based on performance of an individual learner. There can be little doubt at this point as to whether the learner has reached the objective defined at the start. 15 says that evaluation not only means finding out how Nyquist successful an educational activity has been, but also means comparing the costs with the benefits obtained. Cost effectiveness analyses which measure the extent to which resources allocated to a specific objective actually contribute to accomplishing that objective can be done more precisely within a CBE program where specificity is stressed. Lessinger16 discusses accountability for results and recalls the passage of the Elementary and Secondary Education Act of 1965 as a mandate for schools to develop a "zero reject system" which would ensure that education prepare every young person for a produc- tive life. This new objective of basic competency for all can be 17 accomplished through a system of quality assurance. One of the sug- gested ways to contribute to such a system is through CBE. Another advantage of CBE is its relevance for the adult learner 17 refers whose needs are multiple and varied. Dorothy del Bueno to the ability of adults to engage in self-directed learning which can be a part of CBE. In addition she recognizes that placing emphasis on learning - rather than onteaching,which CBE does by having the teacher's role more of a facilitator than impartor of information, is much more compatible with adult learners. If the competencies to be learned are desired, relevant and offered with positive feedback and reinforcement, the adult learner can work independently, given the resources and materials. A CBE process model has been developed by Roberts, Cordova and Saxe.18 It is based on learning theories of CBE and it is suggested that curricula so designed will, in conjunction with accreditation and credentialing, provide another mechanism for ensuring quality in professional practice. These authors compare the characteristics of the traditional approach with those of CBE on the basis of the use of objectives, entrance requirements, class schedules, course content, locus of emphasis and student evaluation. Of these compari- sons, one needs to give particular attention because they have not been mentioned by others in the literature reviewed. It is the tradi- tional focus on instruction - on texts, teaching, tests and grades; the CBE approach directs the focus on the student and the provision of the individualized opportunities to achieve mastery. Of addi- tional importance is student evaluation which in CBE is continuous, 18 with success being measured primarily by the student's ability to do the job, while traditionally it is on grades alone. A model from the University of Texas School of Allied Health Sciences proceeds from the merging of the institutional goals with the philosophy of the professional and the department. The third step in the developmental process is the specification of entry- level roles pertinent to the OT. These authors express the follow- ing concern: "A concern at this point is that the delineated roles and functions give realistic expectations of entry-level performance and are representative of current practices, but fleéible enough to accom- modate future expectations. A case for competency-based preparation of OTs is made by Ander- son, Greer and McFadden20 for those who will be working with the severely handicapped persons in the schools of the nation. It is the instructional module which "has emerged as a viable modus oper- andi for the implementation of competency-based teacher education." These authors refer to Meyen and Altman21 who list the sequence of processes used to design a competency-based teacher training program: competency identification; competency organization; specifications process to reduce competencies into training components; module development activities; module management options alternative to traditional lecture model; evaluating trainee competence through performance assessment and providing feedback on performance to trainees. The use of instructional modules allows students to proceed at their best rate, bypassing unnecessary instruction and focusing on the needs of the learner, not the instructor. Modules emphasize 19 the attainment of objectives which are set when learning begins. It is the authors' opinions that proper certification and account- ability in service can best be guaranteed through competency-based training programs. Anderson, Greer and McFadden state that the profession of occu- pational therapy initiated a movement toward competency-based prepara- tion of OTs in 1972 when AOTA was awarded a grant to develop the knowledge and skills essential for performance in two levels of occu- pational therapy personnel. In 1974 the AOTA "Curriculum Guide for Occupational Therapy Educators" published the project's results. They state that there is a need for further "development and imple- mentation of competency-based training programs in institutions of higher education that engage in the preparation of OTs. Therapeutic objectives must be specified more systematically, learning alternatives should be provided to facilitate better student progress, and faculty and students must be held accountable for achieving the specified objectives. The 'module of instruction' may emerge as a catalyst for the implementation of training programs in occupational therapy."22 23 postulates that CBE, because of its emphasis on stated Barris objectives, feedback, self-evaluation, and alternative learning exper- iences, is an approach to curriculum design that should lead students to become more creative thinkers. The process of creative thinking and of problem-solving have been defined by theoreticians in similar terms. "When one looks at creativity as a problem-solving process entailing an attitude promoted by certain conditions, then education and curriculum assume an important role in furthering this resource in people."24 Barris quotes Carl Rogers who says that a curriculum 20 based on humanistic principles will encourage "concern for self- direction, responsibility for one's own learning, involvement in the present learning experience, and the development of qualities like curiosity, wonder, awe, imagination, commitment, openness and 25 respect for self and others." While CBE need not be associated with a particular philosophy of teaching and learning, it can be congruent with humanism.26 The Barris study points out that although research on the effects of CBEis nonexistent (July, 1978) one can examine studies that look at methods which might be incorporated into a competency-based program. 27 points out that although conclusions of studies say that Davies methods make little difference in learning, these research studies used traditional measures such as the final performance on a test to study effects. The differences, says Davies, may lie in style, motivation, level or type of objective being reached rather than cognitive achievement. Strategies used in CBE such as role-playing, case-studies, independent tutorials, programmed learning and leader- less groups can be individualized to serve the particular objective for which they are best suited. In so doing the learner is provided methods which will not only meet personal needs but also will facili- tate the achievement of the performance objective. As was noted previously, the needs of adult learners are sufficiently unique that they can profit from this kind of variety offered by CBE. Two competency-based programs are discussed in the Barris article: Oregon State University and Northwest Regional Educational Laboratory; and Weber State College in Utah. The Oregon program is a counselor training ”open entry/open exit system." Two types of competencies 21 are involved: outcome-referenced, related to a product, and activity- referenced, related to a process. Students were highly motivated and graduates of the program met the highest performance expectations of their employers. Weber State College, one of the first teacher- preparation institutions to be committed to CBE, organized the program around five components: 1. Structured field experiences, 2. Interaction laboratory to improve inter- personal skills, 3. Weber Individualized Learning Kits, 4. A student teaching experience, 5. A post-student teaching seminar. Problems encountered have been establishing reliability and validity in measures used to assess student performance and a need for more variety in learning experiences. Major strengths are satisfied gra- duates; ability to apply this method to one's own teaching; judged by school personnel to be more self-confident, adaptable, student- centered and better able to fill leadership roles than graduates of other programs. Through the systematic design the program allows for identification of its own weaknesses and for assessment of its progress.28 The implications of this approach for occupational therapy education are first that OTs as educators would find themselves using the same facilitatory skills for helping students plan their programs, analyzing strengths and weaknesses, setting goals and determining paths of action to reach them (courses, modules, field work) which they would use with clients. Since other university courses could 22 be resources for 0Ts, an interdisciplinary approach to medicine and public health could be fostered. Looking at curricula in terms of competencies needed by therapists forces the profession to identify and define what makes occupational therapy different from other pro- fessions, as Wilson says, "by helping it (the profession) attain congruency; namely, to possess a clear statement of what the profession is and then, in fact, to be what it says it is."29 The Barris study's review of several studies provides a rationale for experimenting with an educational program based on a problem- solving model. Also CBE can provide a new perspective for examining process and outcome in occupational therapy educational programs. Moreover the graduates of the Oregon and Utah programs in other disci- plines were thought to be flexible and self-confident which are char- acteristics of self-reliant, autonomous people, unafraid to assert themselves and to engage in problem-solving, which are needed attri- butes in occupational therapy. The issue of the congruency of education and practice was responded to by the immediate past president of the AOTA, Jerry John- son who said the "greatest challenge immediately confronting us in the future may be related to our educational programs and their rele- "30 Pottinger and vance to the practice of occupational therapy. Goldsmith31 summarize the view of several prominent spokespersons on CBE in a collection of individual writings with the same realiza- tion that the gap between those who teach and those who practice needs to be narrowed. It is their thought that professionals and educators need to bring clients and students into the process of 23 defining competencies and entry—level standards in given fields. Although they see CBE as a fashionable bandwagon of the moment, they do acknowledge that it could have a major impact on improving both quality of education and professional service. Despite the fact that initial costs of assessment and evaluation in CBE are high, in the long run better understanding of what constitutes competency and effective delivery of service or job performance - the real costs related to competently meeting social needs as the result of better education, new job definition and improved delivery system - might be low. Wilson32 discusses the relationship of education, practice and credentialing which are the components of professional congruency contributing to quality assurance in service delivery. Congruency is achieved only when the education of individuals preparing for the profession, those already in the field, the credentialing of educational programs and individuals, and the actual practice of the profession relate positively to one another. Competencies, according to Wilson, "are defined as those performance knowledge and skill abilities requisite for fulfilling the responsibilities of the given practitioner generic position."33 Generic position refers to all positions of a given type in the specific professional field, such as all entry-level generalist therapists in occupational therapy. Competency education, the second component of the competency assurance program Wilson presents, prepare the practitioner for entry- level positions. By clearly defining program goals that include professional role responsibilities, the educational faculty provides 24 the practice-education linkage. The determination of the role responsi- bilities or role delineations is, therefore, step one of a competency assurance program. By definition a role is a configuration of speci- fic responsibilities, and role delineation is the determination of the specific responsibilities essential to practitioner goal attain- ment.34 According to Wilson, national health professional associations have yet to put the five components of a competency assurance program together congruently; the most important error is that the first step, role delineation, has never been developed. "The total process must be goal-directed toward identification of the performance respon- sibilities requisite to the given generic position."35 This identi- fication process should have input from the public, other health fields, accrediting bodies and other appropriate groups. This role delineation process becomes the foundation and the goal of initial competency education. The responsibility for assessing the congruency of the educational program with the profession's role delination falls upon the accrediting body. By affirming the validity of the program the accreditors provide accountability to students and public alike. The American Occupational Therapy Association was engaged in a role delineation study from July, 1976 to February, 1978, to delin- eate the role of persons in entry-level positions, providing direct client service only. Administration, maintenance of the clinic, ordering supplies, and all other indirect services were excluded. There had been a previous role delineation study or task inventory done in 1971-72, following the Ohio State University School of Allied Medical Professions project to develop occupational therapy job 25 descriptions and curricula through task analysis. From these identi- fications of competencies the Essentials of an Accredited Educational Program for the Occupational Therapist was implemented in 1974. It is these AOTA Essentials that are the basis for achieving educational accreditation through the AOTA. In the 1976 Anderson, Greer and McFadden study which described a competency-based preparation program for OTs working with the 36 the cluster of competencies covered severely handicapped persons, the demonstration of skill in the selection, administration and inter- pretation of evaluation tools and application of therapeutic activi- ties or remedial techniques for clients who are severely and pro- foundly retarded. These were determined as actual role responsibi- lities in that specific practice setting which serves as an illustra- tion of congruency between practice and education. Other professional education programs using CBE are the Univer- sity of Texas Dental School, Antioch School of Law in Washington, D.C., the doctoral program in management at Case Western Reserve and Alverno College in Milwaukee in Liberal Arts. In occupational therapy the Department of OT in the School of Allied Health Profes- sions at the Louisiana State University Medical Center has a program which is competency-based. Although vocational teacher education was the first to offer a vocational teacher competency profile as a part of the Performance- based Teacher Education (PBTE),37 competency-based professional edu- cation in Home Economics began with the development of competencies and criteria at a national working clinic at Kansas City, February 7-10, 1977.38 Dieticians have developed a CBE educational program 26 also. In 1974-75 a set of entry-level competencies were selected from a Study Commission, American Dietetics Association's Plan IV and other documents. Competency-based curricula have been implemented at the Medical College of Georgia to prepare students to meet entry-level compe- tencies as physical therapists.39 Criteria-referenced evaluations are used to determine if students have achieved the desired competen- cies. The impact of the program has been favorable. Learning exper- iences aimed at helping the student attain necessary competencies for practice are relevant and meaningful; the student is involved as an active partner in the learning process and motivation becomes internalized. To summarize, CBE is an area that is complex, often misinter- preted, but has characteristics that are beneficial to the adult learner and to the certification process of professionals. CBE models have been developed in many professions in conjunction with the cre- dentialing process, for working with client populations, and in entry- level into professional practice. The importance of basing competen- cies on entry-level roles has been stressed and the start of a move- ment toward CBE in the preparation of OTs has been noted. The issue of congruency of professional practice with education has been empha- sized in the defining of competencies and entry-level standards. The relationship of education, practice and credentialing as components of quality assurance in service delivery are linked to competency education positively. 27 Occupational Therappriterature In this section the review of the literature will cover the AOTA Essentials, philosophy, principles and theory, unique and common curricular areas, and a general review within the professional litera- ture of references pertinent to this study. AOTA Essentials of an Accredited Educational Prpgram for the Occupational Therapist The basic essentials for educational programs for occupational therapists are contained in the AOTA Essentials of an Accredited Educational Program for the OT. The Essentials are based on two previous studies concerned with job performance. The first is one done at Ohio State University in 1968-71 in the School of Allied Medical Professions. This project used a task analysis approach to develop job descriptions and curriculum guidelines.40 A 1972- 73 study of the AOTA,41 using a task inventory approach rather than the task analysis approach, focused on those tasks critical to the performance of the entry-level therapist and assistant. Task inven- tory refers to a method of itemizing or counting the functions or tasks required in a particular job or position, while task analysis goes deeper into the study of the functions or tasks by looking at the qualities implied or expected. A model for curriculum develop- ment which incorporates these two methods as the basis for designing instructional units is presented in Figure l. The Essentials state that all occupational therapy curricula will include the following areas of content: 28 L Goal I brat from the American cupational Theta y ‘ nsamfimmrfi ,, In I from the Ohio Task Inventory Occupational Therapists State UnIVCISII) (entry-level) Roles A Functions Task Analysis (comprehensive) Units of general ‘ performance of entry-level _“ Terminal personnel Objectives T Statements of knowledge. Enabling . skills and attitudes Objectives uenu‘al for perform- ance of critical tasks Charts of inter- Otdei relationslup of Objectives knowledge. skills lid attitudes Instructional Units ' Modules of instruction I. STATE THE OVERALL GOAL AND Job SCCI’E OF THE CURRICULUM Proficiency ‘ I II. DEFINE 111E ROLES AND FUNCTIONS OF THE FIELD OF WORK A task inventory and/or analysis that defines the proficiencies expected of entry-level practitioners I III. DESCRIBE TERMINAL OBJECTIVES p.11... mum Meaningful. integrated units of {0, "gum“ of i—i task performance relevant to the ‘_. manned \vorlt situation and critical for Mam instruction. , IV. DESCRIBE ENABLING ORIECTIVES Define criteria ,_ Task componen‘ ts essential to ‘_. for evaluation of the attainment of terminal component objectives. learning ‘1 V. ORDER OBJEC‘ITVES Relationship. hierarchy. sequence II VI. DESIGN msrnucnomu umrsj— Figure I CURRICULUM DEVELOPMENT MODEL’ FOR PROFICIENCY EDIXIATION 5 Adapted from Model of D. Harlin: (mac-d Mn. Inc. Cit. David I. Ilernll led.) Reprinted with permission from the American Occupational Therapy Association. 29 1. Basic Human Sciences Purpose: To understand the structure and function of the human organism and its development from conception to death. Objectives: The student shall demonstrate knowledge and understanding of: A. The structure and function of the human body and body systems. The structure and function of human personality and cognition. The human growth process. Social-cultural systems and the interrela- tionship with individual development and functioning. 2. The Human Development Process Purpose: To understand the development, acquisition and integration of skills, life tasks and roles essential to productive living and mastery of self and the environment. Objectives: The student shall demonstrate knowledge and understanding of: A. Developmental tasks and needs in each period from birth to death. Development of human relationships, roles and values. The impact of non-human environment on normal growth and development. 30 D. The meaning of activity in development of human potential and competence. E. The meaning and impact of symbols and the symbolization process throughout the life cycle. F. The concepts and modes of adaptation and their relationship to performance. 3. Specific Life Tasks and Activities Purpose: To understand and perform the processes involved in selected tasks and activities. To be able to identify and analyze the components which make up tasks and activities. Objectives: The student shall be able to: A. Perform the processes involved in selected tasks and activities. B. Identify and analyze these tasks and activities in terms of the following components: (1) Physical (2) Perceptual-motor (3) Cognitive (4) Psychological (5) Social (6) Cultural (7) Economic C. Observe, identify and analyze tasks and activities performed by others. D. Relate the elements of any task or activity to age-specific needs, capacities and roles. 4. Health-Illness-Health Continuum Purpose: To understand the characteristics of the health- 31 illness-health continuum. To describe and discuss the effect upon the human being of interruptions in, aberrations of and trauma to the developing human organism throughout the life span. Objectives: The student shall be able to: A. Discuss the concept of "Wellness". 8. Define and discuss the etiology, progression, management and prognosis of the following: (1) (2) (3) Congenital and developmental defects and deficits Disease processes and mechanisms Physical, emotional and environmental stresses and trauma C. Describe and discuss the effect of the above upon optimal human functioning. D. Recognize and identify manifestations and symptomatology of health and illness. 5. Occupational Therapy Theory and Practice Purpose: To be able to apply and utilize the theories and principles of occupational therapy. Objectives: The student shall be able to: A. Serve the individual client by: (l) (2) (3) (4) (5) Evaluating his performance capacities and deficits. Selecting tasks or activity experiences appropriate to his defined needs and goals. Facilitating and influencing his partici- pation and investment. Evaluating his response, assessing and measuring change and development. Validating assessments, sharing findings and making appropriate recommendations. 8. Provide consultative services in relation to the profession and its function. 32 C. Provide administrative and supervisory leader- ship for occupational therapy programs. D. Facilitate and participate in community health care planning and activities. E. Promote, plan, implement and conduct research for the benefit of the public and the growth of the profession. From these Essentials and the AOTA Task Inventory, suggested con- tent for each objective in the Essentials has been included in Chapter 7 of A Curriculum Guide for Occupational Therapy Educators.42 It is from this listing of content areas that the existing competencies will be drawn. In order to determine which part of the content is unique to occupational therapy, a review of the litera- ture in occupational therapy was done. This review follows. Occupational Therapy Literature Related to Philosophy, Principles and Theory In November, 1978, the Representative Assembly of AOTA met in special session to address issues affecting the entire profession. Selected leaders of the profession over the past few decades were invited to address the meeting to provide direction and a broad per- spective base. These presentations have been assembled in a monograph entitled Occupational Therapy: 2001 AD.43 The following AOTA leaders have identified occupational therapy philosophy, principles and theory. Wiemer says that the uniqueness of occupational therapy lies in the basic knowledge of occupation. "Our exclusive domain is "44 occupation. The "impact of occupation upon human beings" was spelled out as the sole claim to professionalism by the founders 33 in 1917.45 In 1918 a government bulletin stated that occupational therapy "is the science of healing by occupation. "46 Wiemer outlines the basis of occupational therapy or the impact of occupation on the human being, under the following headings (Figure 2, page 34): I. II. III. Dynamics of occupation in routine human living. A. The concept of occupation as a force in normal human development The concept of occupation as a force in the equilibrium of health Dynamics of occupation in the presence of illness, injury, dysfunction, deficits. A. The concept of the distortion of the normal dynamics of occupation in the presence of imposed or acquired illness, injury, health deficit The concept of the distortion of the normal dynamics of occupation in human beings in the presence of illness, injury, or deficits at or before birth Dynamics of occupation in the management of illness, injury, dysfunction, deficits. A. The concept of selected use of occupation as a force in identifying and assessing health problems The concept of occupation prescribed for goal achieve- ment in human development The concept of occupation prescribed for specific goal achievement in the presence of pathology Wiemer further says that the components of occupational therapy are its science, art and practice, as explained in Figure 3. 34 .mcwme cease me» :e :ewpeeeeee we peeeEw one . anecmcu Feeewueeeeee we mwmee mew .N «gnaw; meewuecew Avon we auw>mmee4 .oucepmwxm case; we meweeee eee mewe> . meewpecew ween we mmwuweeeeo u cute: cease we haw—e30 . meewpueew ween we wwwxm . meewpecew heee we auwweeo l magma hues eee mean we euwm i "eweeeeweucw .e>wue=gumme .pwewwee .weewmcee .mweeueeooe .Eeswuee . .euwee; we Escueeem we» cw mcweewueeew Avon ea meuewoe aw me cewpeeeoee cw :ewueewewuceeieec Le cewueewewesee ease; secw eeueewewuce we eu meseouee e>wpemme eee m>wuwmee mew "cu—.mmz we EzwanFwDUw m...» cm wugow 0 mm cowuwnzuoo Lb unwucou 9:. .m .eewmmmemme emeeemu nee apewxee we mecmmee Le .mwwwxm mew>wemieeweece upeee eu mmoeewceexe xewe m>wuemeo we ewzmcewpewmc ..m.e eweegeem i meeeewpeee Fences i Pawnee ecemwew . 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Figure 3. The components of occupational therapy. 37 West says that ”the core of our profession's being is activity or occupation that is purposeful, meaningful, and structured to accom- plish specific therapeutic objectives."47 The philosophical base of occupational therapy was identified by Hopkins (says West) as "the pioneers who fashioned the profession believed that the health of individuals was influenced by 'the use of muscles and mind together in games, exercises and handicraft' as well as in work." Gillette and Kielhofner state that occupation and related con- cepts reflect the "inherently powerful philosophy upon which occupa- tional therapy rests."48 49 Hopkins, in an historical perspective recalls that in the Army Manual on Occupational Therapy, Bird T. Baldwin says that occupational therapy is based on the principle that the best type of remedial exercise is that which requires a series of specific voluntary movements involved in the ordinary trades and occupations, physical training, play or the daily routine activi- ties of life. In 1915, Dunton, according to Hopkins, said that treat— ment was based on these principles: - directed to individual needs; should arouse interest, courage and confidence; should exercise mind and body in healthy activity; should overcome disability and reestablish capacity for industrial and social usefulness; should be regulated and graded as a patient's strength and capabilities increased; employment in groups is advisable to provide oppor- tunity for social adaptation; only reliable measure of the treatment is the effect on the patient.50 Spackman, says Hopkins, emphasized that constructive activity is the keynote of occupational therapy. Hopkins summarizes occupa- tional therapy principles in four propositions: 1. The use of occupation or purposeful activity can influence the state of health of an individual; people 38 have a need to self-actualize through work or leisure activities; occupational therapy's goal has remained to correct or ameliorate whatever prevents self-actuali- zation. 2. Individuals and their total functioning must be viewed in respect to their environment and remediation must take into consideration all the physical, psychological and social factors. 3. Interpersonal relationships are an important factor in the occupational therapy process. 4. Occupational therapy is an adjunct to and has its roots in medicine and must work in cooperation with medical professionals and other persons involved as health care providers to assure maximum benefits to clients. Although Hopkins says that theoretical propositions by Ayres, Reilly and Mosey form the beginning of occupational therapy's unique body of knowledge, she states that the profession as a whole has not identified the characteristics of occupational therapy which make it unique - no single perspective has been identified and accepted by the total profession.51 However, since these propositions are being researched to provide regulation and validation, they need to be considered among the core principles of the profession. Ayres' sensory integrative approach, Reilly's occupational behavior approach, and Mosey's developmental approach, as well as Rood's neurophysiolo- gical approach, must be included in the unique core of the profession. From the Curriculum Guide for Occupational Therapy Educators another perspective on uniqueness is found. Tasks that provide direct 39 service to clients and program support are initial screening, evalua- tion, planning, implementation, re-evaluation, unit managing, supply and equipment managing, communicating with groups and staff develop- ment (Figure 4). These represent the processes in occupational therapy practice. To make a curriculum unique and specific for stu- dents of occupational therapy, a second dimension is needed: the identification of situations in occupational therapy for which the processes are performed. Through the integration of process with situation, the process becomes meaningful for occupational therapy practice.52 Reference to situations is used in the context of a person's ability to perform life roles and human functions within a particular life space. From the AOTA Project to Delineate the Roles and Functions of Occupational Therapy Personnel these terms are defined: "Occupational Performance: the individual's ability to accomplish the tasks required by his or her role and related to his or her developmental stage. Roles include those of a preschooler, student, homemaker, employee, and retired worker. Occupational performance includes self-care, work and play/leisure time performance. "Occupational performance requires learning and practice experiences with the role and developmental state-specific tasks, and the utilization of all performance components. Deficits in task learning experiences components, and/or life space, may result in limitations in occupational performance. "Performance Components: the learned and developmental patterns of behavior which are the substructure and founda- tion of the individual's occupational performance. The performance components include: motor functioning sensory-integrative functioning cognitive functioning psychological functioning social functioning. (DQOU'DJ "Life Space: includes the individual's cultural background and human and non-human environment.53 40 ROLES AND FUNCTIONS OF OWUPATIONAL THERAPIST AND OCCUPATIONAL THERAPY ASSIST ANT AT ENTRY LEVEL OF COWETENCY TASKS THAT PROVIDE DIRECT SERVICE TO CLIENTS W Assistant Identifying sources of info. Explaining semces INITIAL Plan/supv. data collection Obtaining info. re needs SCREENING Integrate/interpret Recording/reporting Formulate reconunendatlons Select/plan methodology Intemevvmg/reportlng Evaluate/ test Obsemng/reportlng EVALUATION Integrate/interpret Discussing with client Discuss findings Testing (self-care) Record/report Anisting with testing Goal setting Goal setting (self-care) PLANNING Plan/select methods] Selecting/planning activities (self-care) hectdlreport Discuss plans with client Preparing/orienting Preparing Instruct/supv others Orienting client Supv. design/construct. Instructing IMPLEMEN- Analyze/summarize perfor. Design/construct adapt. 1. ATI ON Change/adapt equipment Discuss/word. with others Structure/adapt actmty/ Record/report envlr. Obsemng Reporting Initiate reevaluation Review date Evaluate/test Test (self-care) RE- Analyze Anisting with evaluation EVALUATION Recommend Terminate/followup Terminate/followup Record/report lecotdlreport PROGRAM SUPPORT TASKS Therapist Assistant UNIT Scheduling Scheduling/recording Budgeting/free setting Budgeting/recording NANAGING Pla . nning/proiectlng Escortlng SUPPLY '“"'"‘.°" Ordering AND Ordering Storing EQUIPMENT Preparing MANAGING Maintaining COMMUNI- Prepare professional Prepare general written CATING written material material WITH Speaking to public groups Speaking to public groups GROUPS Speaking to professional groups Orienting Onentlng volunteers Supervising volunteers Supervrsing volunteers STAFF Supervising COTA’s Participating tn In- DEVELOPMENT Participating in Servrce ln-Service Training volunteers Providina In-Service — FUJI!” Prendlefereece.m0lse: ProoeesuhOeaspetIcneITbsrapyPtaetice 41 The content of the occupational therapy process is, therefore, the knowledge of occupational performance skills necessary for a person's life role in a particular life space. It is this knowledge of the impact of occupation on the human being to which Wiemer referred to as the science of occupational therapy; implementing the dynamics of occupation as the art of occupational therapy; and the skillful management of the art and science of occupational therapy as the practice of occupational therapy. The philosophical base of occupa- tional therapy is contained in a resultion passed by the Represen- tative Assembly of AOTA in April, 1979: Man is an active being whose development is influenced by the use of purposeful activity. Using their capacity for intrinsic motivation, human beings are able to influence their physical and mental health and their social and physical environment through purposeful activity. Human life includes a process of continuous adaptation. Adapta- tion is a change in function that promotes survival and self-actualization. Biological, psychological, and environmental factors may interrupt the adaptation pro- cess at any time throughout the life cycle. Dysfunction may occur when adaptation is impaired. Purposeful activity facilitates the adaptive process. Occupational therapy is based on the belief that purpose- ful activity (occupation), including its interpersonal and environmental components, may be used to prevent and mediate dysfunction, and to elicit maximum adaptation. Activity as used by the Occupational Therapist includes both an intrinsic and therapeutic purpose. Summary of Occupational Therapy Literature ReTated to Philosophy, Principles and Theory The philosophy of the profession expresses its beliefs. From the basic knowledge of occupation comes the content of occupational therapy process, which, as science and art are "managed" in the prac- tice of occupational therapy. To identify the competencies which are unique to the profession, the AOTA Essentials were reviewed to 42 ascertain the content from which the competencies could be taken. The following sections will, therefore, comprise the content specific areas: 1. The Human Development Process: the meaning of activity in development of human potential and competence; the meaning and impact of symbols and the symbolization process throughout the life cycle; the concepts and modes of adaptation and their relationship to performance. 2. Specific Life Tasks and Activities. 3. Occupational Therapy Theory and Practice. General Competencies within the AOTA Essentials The AOTA Essentials cover all curricula content that is required in the professional preparation of OTs - both content unique to the profession and common to other health professions. The areas of the curricula which are the source of the competencies common to all health professions are the following: 1. Basic Human Sciences A. The structure and function of the human body and body systems. 8. The structure and function of human personality and cognition. 43 C. Social-cultural systems and the interrelationship with individual development and functioning. 2. The Human Development Process A. Developmental tasks and needs in each period from birth to death. 8. Development of human relation- ships, roles and values. C. The impact of non-human environ- ment on normal growth and development. 3. Health-Illness-Health Continuum 4. Program management and supervision; consultation. 5. Promotion, planning, implementing and conducting research (not con- sidered entry-level functions in the AOTA Task Inventory). A Re-Entry Project at Western Michigan University has done a needs assessment study of job descriptions of OTs in the field 44 work centers of the Occupational Therapy Department at Western.54 The centers are located nation-wide and cover experiences in physical disabilities and psychiatry in hospitals, clinics and schools. The results show that in all of these settings the over- whelming emphasis is on administrative and supervisory functions for both chiefs and staff therapists. Employers of OTs, according to this study, expect therapists to have administrative and supervisory skills when they are first hired. Literature References to Educational Areas Most of the articles reviewed dealt with curriculum design or learning strategies. Llorens and Adams examined the learning style preference of OT students. Their results indicate a pre- ference for learning conditions which permit knowing and liking the instructor personally, setting one's own objectives and working alone and independently - the last two criteria being ones which are a part of CBE. Direct experience was preferred; listening and iconics was next, and reading was lowest.55 Silva56 describes the components of program development and curricula design. Following the statement of purpose there are: "deliberations about separate domain or reintroduction must be deter- mined; followed by identification and explanation of the core arguments 45 that characterize the field; content competencies are the output of the student. In another reference Silva discusses the difference between a discipline and subject matter: a discipline has a regulated set of premises that serves as a basis for explaining the core argu- ments identified as the unique body of knowledge; disciplines remain constant, subject matter changes to meet crises of living and to accommodate contemporary points of view.57 Jantzen says that "our grounding educationally is too weak to ensure competency in the entry-level member, and we persist in the 58 This notion that on-the-job training will make up for the lack." writer suggests a move to professional level being post baccalaureate with concentration on four areas of specialization determined by age: pediatrics, geriatrics, adult psychiatry and adult physical disabilities. Ford surveyed occupational therapy schools to assess clinical exposure to the field of mental retardation.59 In summary, most curricula covered mental retardation as a part of several courses; 11 universities did not offer any course but compensated by offering preclinical observation and experiences. Nord suggested an interdisciplinary educational program using a core curriculum approach: "learning together in order to work together."60 From a survey to determine courses which were or could be shared with other professionals, the Basic Sciences were dominant. Christiansen points to a need for earlier client contact and increased attention to the development of administrative and managerial skills and courses designed to facilitate skills necessary for effective 61 interpersonal relationships. Eliason and Gohl-Giese raise the 46 62 Since the AOTA Essentials do issue of professional boundaries. not describe specific curriculum content, the faculty has responsi- bility to determine the kind and extent of coverage needed to prepare entry-level therapists. There are many modalities to choose from and without standards in curricular areas, guidelines must be given students as to treatment methods that are occupational therapy and those not. Fidler looks at the implications for education of specializa- tion.63 Without the coherence of an occupational therapy discipline, without a substantive base in occupational therapy per se, speciali- zation risks focusing on developing expertise more relevant to other professions than to OT. Without a generic frame of reference for occupational therapy, specialization is more phantom than real. The writer goes on to state that the profession must confront the issues of a solid, rigorous basic education and must delineate and describe the generic occupational therapy focus and content of entry-level education. The search of the literature to find specific examples of curri- culum content related to specific competencies reveals few citations. Barris investigated the implications of CBE for developing creativity in 0T5 as an approach to problem-solving, a skill much needed by OTs.64 Roberts, Cordova and Saxe describe a process model for design and development of curricula based on learning theories of CBE.65 Allen and Cruickshank studied problems of beginning therapists as a first step in reproducing the problems in simulations for classroom use - a teaching strategy.66 Anderson, Greer and McFadden identified 47 two clusters of competencies that could be applied to the severely, profoundly retarded client:67 1. The OT will be able to demonstrate skill in the selection, administration, and interpretation of evaluation tools for clients who are severely and profoundly retarded. 2. The OT shall demonstrate skill in applying therapeutic activities or remedial techniques for severely and profoundly retarded clients. Cromwell and Kielhofner developed and implemented a model of training that prepares students for community practice, as a part of the occupational therapy curriculum at the University of Southern Cali- fornia.68 From this review of the literature related to competencies in occupational therapy curricula it is evident that most references are to curriculum design, teaching strategies, educational issues relevant to the profession, and the potential use of CBE in occupa- tional therapy programs. If other competencies are being taught, some other method of retrieving this information would have to be used. Literature Related to Emerging Competencies The literature in occupational therapy is replete with references to changing roles, models of practice, and emerging implications for education. The following writers were selected because of their significant contribution to this study. 69 Ethridge spoke from the management view of the future of occupational therapy in mental health. Changes in the field over 48 the past ten years have prompted a necessary change in the role of the OT. Decline of state hospitals, court decisions and new laws have resulted in a new atmosphere in psychiatric practice. The Com- munity Mental Health Movement, started with legislation in 1963, had a budget in 1975 of $75 million for 5,000 employees treating 200,000 clients. The state hospital has decreased the number of patients and has in essence become an acute care center since the chronic problems have moved to the community. Long term clients are scattered throughout the community and are in need of innovative programs to address their needs. Professionals must pool thoughts with administration and legislature on ways to deal with these people or the legislature will dictate. For OTs Ethridge says that it means redefining the role of psy- chiatric practice. Therapists must be trained for non—hospital loca- tions, and become an organizer, developer, and implementer of approaches to serve the re-located clients. First, however, OTs must accept this mission; next, curriculum change is necessary. The basic introductory course in occupational therapy education "is prob- ably one of the few valid subject areas remaining in the professional curricula today."70 Some suggested changes are the following: 1. Clinical experience should move to the community (out of the hospital). 2. Course work in individual counseling, community development, budgeting and finance, adult education, administration and management are all necessary. 3. Train through graduate education persons for key administrative management positions. 49 4. Specialization comes through experiences; graduate education broadens one's perspectives. 5. It is now necessary to train community organizers, program facilitators and therapists for administration. Will occupational therapy lead or follow? Johnson71 wrote on changing from helping the individual patient to providing service to the whole of society by working to prevent disability and dependence. In a presentation before the Canadian 72 Johnson said that Association of Occupational Therapists in 1977 theiprofessiont.belief in humanism or humanitarianism is in conflict with the imposition of accountability procedures. This is only one example of a conflict in values, attitudes and conditions which pre- vailed at the founding of the profession and which are in need of change today. The fact that the profession is primarily one of women imposes beliefs that, although changing with the pro-feminist move- ment, continue to offer resistance. An example of this is, according to Johnson, the lack of knowledge about dealing with political or financial matters - a much needed involvement now and in the future. Also, therapists cherish the one-to-one relationship which focuses on the "use of self" as a therapeutic tool without relating this to defined goals that the consumer values and can experience as having contributed to improvement. Since the content of our educational programs reflects the profession's beliefs and attitudes, change must first be made in these before the course content can be revi- talized. 73 Lewis wrote in 1975 about assuming a leadership position in geriatrics. Statistics show that by the year 2000, 32.3% of the 50 total population will be over 65 years. OTs have a responsibility to serve this population by the following: 1. Commitment of the therapist to keeping informed about current legislation, benefits, services available to this population (The Older Americans Act). 2. Sharing this information with clients. 3. Keeping current in treatment methods. This may suggest a role in the nursing homes, but can also indicate home health services with an emphasis on independent living as long as possible. Shore74 stresses the need for public policy in long term care: if the acute medical disease model falls, new models must look at nursing home hearings, scandals, reasonable cost related reimbursement, alternatives to institutionalization and the mental impairment as a catastrophic illness - all of which have direct impli- cations for OTs. Katz, Ford, Downs, Adams and Rusby did a study of the effects of continued care75 in 1972. They studied the effects of continued care of chronic disease patients discharged from rehabilitation hos- pitals as measured by outcome criteria: restoration or maintenance of function and survival. Outcomes of the study were that beneficial nursing effects were among the youngest (SO-64 years); more patients were hospitalized among the oldest; more non-nurse and non-physician professional services among the relatively economically independent. Implications for OTs point to an increased practice with 50-64 year- old persons and with geriatric chronically ill persons through medi- care and medicaid funds on an out-patient or at home basis. This suggests the need once again for political expertise to influence 51 the obtaining of coverage for the services of the OT by third party payors and for developing skill in team functioning. An unpublished paper of Katz spoke this need for a multidisciplinary team of medical specialists to serve the chronically disabled patient. Ford and Katz76 studied the prognosis of patients after stroke with results showing that the majority of recoveries occurred within six months after the stroke and with little likelihood of recovery after two years. At the end of two years, six out of the ten required no per- sonal assistance with walking, and minimal help with activities of daily living. These data suggest that OTs continue to be involved immediately after the stroke and put all emphasis on the six months post stroke period - a time when the client will be in the hospital but for a greater time will be at home. Again this suggests out- patient or home services for which third party payment for services is needed and if in the home, also implied that the OT could be pro- viding home health services on a fee for service basis or as a part of a Visiting Nurses Association or some such home provider. The implications here are for private practice skills which fall within the business - management sphere of influence. Cromwell and Kielhofer77 described an educational strategy for the educational preparation of OTs to be a community health specialist: someone who can move into non-traditional settings, be skillful in program development and more mature in assuming responsibility for the demands of lay persons and professionals. OTs must learn first that disability and health are not mutually exclusive. The process is Jim Kent's Discovery Process which gets a description of a com- munity - its culture, the people physically, socially, psychologically 52 and economically, in order to obtain the key environmental factors that directly influence health. Only by so doing can the therapist design a health system that fits that culture. The writers say that as the profession moves toward community practice, the educational program must balance preparation of students for both the traditional hospital practice and community health roles. 78 used this process for discovering the lifestyle of Marnio the physically disabled. This therapist taught OT students the Dis- covery Process in order to put emphasis on the person, instead of the diagnosis. Describing, documenting, focusing, reflecting, plan- ning and implementing were the parts of the process in which the student participated. The ecological frame of reference which looks at life style as a basis for understanding a person in a particular setting, is useful when helping clients set goals and work toward attaining them. Issues in occupational therapy education are similar in Canada and the United States. Woodside79 wrote in 1975 about eight different educational issues of importance to Canadian OTs, one of which dealt with the new focus on "health" rather than "ill health". There had been concern as to whether some health workers were continuing to emphasize acute curative work to the exclusion, in some cases, of preventive health care. From this Woodside suggests that the credi- bility of the educational programs might be strengthened by examining and documenting the amount of content pertaining to "health". Addi- tionally, clinical internships might include areas such as health maintenance, leisure and retirement planning, and environmental alter- ations to improve health. Trends in health care discussed by this a1 53 writer included reference to a paper given by Dr. Muriel Uprichard at the World Federation of Occupational Therapists Congress in 1974, in which she noted that the medical model was defined by a division of subject matter into body systems and disease states. As a nursing educator, Dr. Uprichard described a curriculum focused on the biolo- gical system of the medical sciences; the personality system of the psychological sciences, and the social system of the social sciences. A Queen's University study in Kingston, Ontario, surveyed OTs to find out what they were thinking about the profession.80 Several conclusions were drawn: 1. Since physicians had fought the battles for OTs for so long, this medical leadership deprived OTs of a tradition of leadership experience to draw upon. OTs in the study did not know how to get into the arenas of power, nor did they know what strategies to use once in that arena. And even if someone were to push an OT into the leadership positions, they would not want to go. Only ten of the 835 respondents to the questionnaire ranked the chance to exercise leadership as first in importance among their life satisfactions in a career. 2. There was much dissatisfaction with the political effort required to keep the profession going. Unfortunately, the writer said, this political activity is a necessary evil in professional life. When considering occupational therapy as an economic alternative, it is going to require political skill and effort to implement the goals of the profession in this regard. 54 3. Regarding education, the OTs who had graduated since 1975 (between 1975 and 1977), expressed the most dis- satisfaction in areas of research, administration (including departmental management, public relations supervision and program design), and professional involvement (knowledge to formulate professional and health care policy, and knowledge of trends in health care). 4. When looking to education in the future, the respondents stressed the need for training in research, treatment and evaluation; of lesser importance were professional involvement and administration. The implications of these educational problems, stated the writer, are for there to be a change in attitudes and skills of the present practitioners first, since time cannot wait for educational change. The practical aspects of occupational therapy need to be transferred to the political arena - OTs must play the role of the practical politician. 81 was mentioned in the dis- The biopsychosocial model of Mosey, cussion of the profession's theories and concepts. According to Mosey, this model directs attention to the body, mind and the environ- ment of the client, without any consideration for wellness or illness. The biological aspect focuses on the anatomy and physiology basic to occupational therapy practice; the psychological portion, to con- cern about normal human growth and development, and deficits in the maturation process; the sociological to concern for a person as a group member. All of these interpretations lend themselves well to 55 theory development and operational principles. The assessment and delineation of the individual's learning needs relative to the objec- tives of the model refer to the initial evaluation, which suggests a knowledge of basic principles of measurement and testing; planning refers to the considerations of the teaching-learning process which is a part of the client's personal program; and evaluation of the effectiveness of the learning experience is continued evaluation - requiring the same skills and knowledge as for the initial evaluation. This model is oriented to the client-in-community, and more of the connotation of working together to solve problems in living. Since this non-medical model is more teaching centered than treatment cen- tered, the therapist must draw upon many different theories of teaching and learning, which points to specific competencies that must be acquired. Dunning emphasized the importance of environmental occupational therapy, a way of looking at people, space and tasks.82 From environ- mental psychology comes this theoretical foundation, which overlaps with an ecological-systems approach. Each stresses the effect of the environments on persons in terms of role performance, learning, and other tasks which take place in different life spaces. Familiar- ity with research in environmental studies should add to the OTs skill as managers of space, people and tasks. Opinions of Leaders in Occupational Therapy from the Representative Assembly Session in November, 1978 Since there were many issues of importance to the profession nationally, the Representative Assembly met in special session to 56 deliberate over proposed resolutions and to hear from leaders in the profession. Their comments provided a firm foundation for pro- posed changes. 83 illustrated traditional and nontraditional practice Wiemer arenas in occupational therapy. She has identified, namely, the OTs' function, role, objective of treatment, focus of treatment, the site and access to clients over a time period from the traditional, to the transitional and the contemporary. It is noteworthy that the sites have shifted from the one-to-one therapist-client relation- ship in hospitals to the HMO, home health, day care, school, housing, industry, workshops, prisons, community, health administration. Wiemer believes that the profession must move to the master's level in order to develop the science of occupational therapy. A product must be built that is useful in the traditional arenas and saleable in non- traditional ones, ultimately reaching to the fundamental management of human living. As the president of the AOTA looked into the future, Mae High- tower-Vandamm suggested that there would be no institutions84 - all living would be community-based; activities would be the strongest forte of the OT and a performance evaluation would accompany an acti- vity history; the role of preventive care would be important for all; early intervention in treatment programs for children would begin at birth; and planning for activity throughout the lifespan would be commonplace. Each of these ideas suggests an emphasis in educational preparation. 85 Johnson suggests that if OTs want to be an independent health profession consideration must be given to the implications for 57 education, for legislation, for reimbursement potential and for li- censure as well as for the type of individual who will be attracted to the profession. This kind of independence requires competencies quite different from the clinician of today. Cromwell86 believes that the profession's future model will be similar to that of Somers, which is a health promotion/health protection model using health education as a basic ingredient. For this kind of model OTs will practice in the community, "as generalists, acting in the role of the catalyst for helping patients/people solve increasingly complex problems of functioning in a highly technical "87 Such roles as one in home health with OTs coordinating society. and supervising health homemakers and aides, a Community Care Work- shop with OTs directing and operating this multi-service center where learning about normal human needs could take place; long term care with OTs assisting with normal life roles. To do these things means that the profession must reassert the fundamental philosophy of occupational therapy - the use of therapeutic activity as the catalyst for acquiring or maintaining basic living skills. Additionally con- sider a coalition or consortium plan in which OTs join other activity technologies and home health personnel. Yerxa88 reviewed the implications of conflicting values held by OTs and by the profession's leaders toward the profession. Deci- sions about education must be made after these conflicts have been resolved, so that there will be a concerted effort to attract persons to the field who possess the same values as the profession espouses. However, the point that Yerxa makes about these conflicting values eminating from what the OT schools teach and what leaders not in 58 education profess, is worthy of consideration. First it will be necessary that the professional socialization process be explored to discover the subtle system of rewards and punishments employed, so that these can be reconciled with goals which the changing health scene is imposing upon the profession. Gillette89 explored the relationship of practice - research - education, and proposed several "musts" for educators and the profes- sion. First, educators must assume the responsibility for the development of knowledge, rather than being protectors and transmitters of already existing information. The profession must commit itself to innovative research and reflect this commitment when attracting new students. Clinical education, as an integral part of the sociali- zation process, must transmit a professional identity including skep- ticism, initiative, scientific inquiry, and the development of pro- fessional and ethical ideals. Research must become a part of the problem solving effort which confirms theory, and be integrated as a regular part of each course of study. As Gillette said, the students will model the thinking patterns of their mentors, so it is the edu- cators' task to link practice and research to education. As educa- tion establishes cause and effect relationships between purposeful activity and the components of occupational performance, therapeutic modalities will take on their appropriate meaning. The AOTA Task Force on Target Populations of the Representative Assembly was given the charge to identify client populations needing the expertise that is uniquely that of occupational therapy and to rank order their priority.90 This report, submitted in 1974, viewed the profession in transition - from services which are client-centered, 59 based in medical institutions and directed primarily toward dys- function resulting from diseases, to identifying problems which can be met by OTs in the home, community or social institution, using systems intervention or indirect service - moving toward a primary care role, assuming responsibility for supervising and coordinating programs in occupational performance. The recommendations of this report included the following: 1. Undertake activities to enable the profession to become uniquely definable, independent health one. 2. Examine, refine and validate theories related to practice and strengthen the educational programs by ensuring that curricula and field placement centers utilize such frames of reference as the foundation for educational planning. 3. Continue to identify human health needs ..... as these impinge upon occupational performance. 4. Efforts to help occupational therapy become a unique definable independent health profession should start with developing models of practice. The AOTA published a book titled Consultation in the Community: Occupational Therapy in Child Health in 1973. Several leaders in the profession documented the transition from a medical to a health care model of practice in which OTs function in community health: furnishing indirect treatment, having supervisory and consultant roles as health agents and advocates. Emerging competencies will be drawn from a review of this compilation of writings of leaders in the field of occupational therapy. 60 Implications of Social Policy Legislation This review of the literature will encompass social policy legis- lation which has a direct affect on occupational therapy practice. Social policy legislation is chosen as a relevant source for identi— fying the constraints of social systems in which OTs are or could be working, and for drawing from the public law the specific educa- tional and research implications suggested. The following laws will comprise the review: 1. 4. PL 93-112: The Rehabilitation Act of l973,_Amend- ments of 1978.91 This legislation offers a broad area of practice for OTs. PL 94-142: Education of All Handicapped Children Act of 1975.92 As mentioned in Chapter I, this law has already provided many new opportunities for 0Ts as reflected in the increased numbers of therapists working in the school systems. PL 93-222: Health Maintenance Organization Act of T973.93 Since much of the literature in occupa- tional therapy has for some time described a role for therapists in preventative medicine, the Health Maintenance Act, which legitimizes the Health Maintenance Organizations (HMOs), creates a setting for this kind of practice. PL 93-641: National Health Planning and Resources 94 In addition to the Development Act of 1974. regular practice arenas, OTs can and should be involved at the health planning phase of health 61 care. This Act has made it easier for this to happen. 5. PL 92-503: Social Security Amendments of 1972.95 Quality of health care has long been a goal for evaluators. To make this possible it was thought that by creating Professional Standards Review Organizations (PSROs) there would result quality health care services. PSROs now exist in hospitals and nursing homes and require the participation of health practitioners in these settings. The implications for OTs are many. These five public laws will be discussed using an outline that includes the intent of the law when first conceived, a brief summary of particular provisions, the scope of service with particular refer- ence to occupational therapy, and the educational and research impli- cations that suggest competencies which are among the emerging ones needed for nontraditional practice, as well as the traditional set- tings. A list of the competencies suggested by these laws and other literature review is in Appendix A. PL 93-1!é: The Rehabilitation Act of 1973, Amendments of 978 jgtgppz Starting in 1917 with the Vocational Education Act of that year, Congress has intended to provide services to handi- capped people so they can contribute to the work force within the society. Provisions: Although Section 504 of this act, which opened doors for employing handicapped persons on a non-discriminatory basis, 62 is understandably important, of greatest relevance to 0T5 is the provision for Comprehensive Services for Independent Living. Based on this part of the law, service would be delivered to severely dis- abled young and old in their homes. Scope of Service: Federal regulations include occupational therapy as a "physical and mental restoration service" which may be provided in a rehabilitation facility to render a handicapped person employable. Occupational therapy service can be to do the following: 1. Provide input to the State Plan regarding current and future needs for programs and services as perceived by OTs. 2. Assist with evaluation of the client for individualized rehabilitation programs; assess the ability of the client to perform activities necessary to live and function in various life spaces. OTs are particularly trained to do this with the severely handi- capped person. 3. The "independent living rehabilitation" (ILR) program with authorization of Comprehensive Services for Independent Living funds professional services to assess and train skills required voca- tionally, and in self-care. One purpose of this part of the law is to establish people in the community through a supportive service network, in which OTs could be a part of the rehabilitation team. 63 OTs will need to learn about the vocational rehabilitation system, how to access it and how to define thier role. Although vocational rehabilitation has its own vocational evaluators, OTs are also trained to provide this service, particularly with the handicapped population. An educative role will be necessary so that OTs can acquaint others with their particular competencies. Educational and Research Implications: For OTs in an unfamiliar system, in clients' homes and work settings, communicating to others the uniqueness of occupational therapy. 1. Learning how to access the system; do a comprehensive needs assessment, write a proposal, be effective in public relations and communication skills; know where to gather information about public laws - for families and for the professional. Know how to define a new role in a new system which is not a part of the medical model. The president of AOTA said in 1979: "When I first graduated from Columbia, the glamour program for young 0T graduates was vocational evaluation. Whatever happened to that? Now, we have vocational specialists ...vocational evaluators, work evaluators. The OT is the only professional I know who has the training to look at a total person. We were perfect for the job, yet, while we were solving the problem of how to deal with this, another group of professional§7emerged and took that role away from us." Know how to work in the community; in the client's home living space - problem solving and creatively adapting solutions to help clients live productively and meaning- fully; giving service without the backdrop of an 64 occupational therapy department with standard equipment. 4. Work as a team member with rehabilitation engineers to assist clients through the construction of adaptive equipment; doing task analysis of client's jobs and recom- mending refinements to meet individual needs. 5. In the homebound setting, learn more about family ecosystems, management of resources and interrela— tionships. 6. Know how to document precisely the client's problem and the client's goals. 7. Engage in studies of the evaluation of service out- comes in order to assess the quality of service performed. 8. Acquire administrative and consultative skills; know how to educate clients, develop and use community resources and natural caretakers. 9. Become familiar with the ecological model which empha- sizes the interaction and interdependence of systems and persons within, as well as linkages. PL 94-142: Education of All Handicapped Children Act of 197598 lptggpt To provide equal educational opportunities for all children. In essence this says that education is a continuous process by which individuals learn to cope and function within their environ- ment, regardless of their environment.99 Provisions: The law provides for a free, appropriate public education for all children and for protection of children's and parent's 65 rights. OTs are identified as related services "required to assist a handicapped child to benefit from special education."100 Scope of Service: The locations of practice for occupational therapy in school systems are in intermediate school districts, local elementary and secondary schools and school programs in the institu- tions for the retarded and mentally ill; nursing homes where students live and sheltered workshops where students are enrolled, as well as the homes of students (usually those under 3-5 years). OTs work in settings which are non-medical, teaching oriented and in a system having policies, rules and philosophy quite different from the medical system. OTs function in direct service and non-direct service roles - as providers of one-to-one treatment, and consultant to teachers and parents regarding the handicapped child's abilities to perform skills of daily living. Administrators within the system are unfami- liar with OTs and what they are trained to do; teachers are in need of problem-solving help with handicapped children so that they will be able to develop cognitively, and parents want to know how they can help their children grow and develop. The role of team member has become the most needed one for OTs. Educational and Research Implications: The new non-medical settings present the following implications since therapists have not been trained for this role. 1. Ability to live with ambiguity and to structure a new role in an unfamiliar setting and system. 2. Acquiring public relations skills to get along as strangers on another's turf. 66 Understanding the core of occupational therapy to the extent that they can communicate it clearly and simply. "The core" refers, in this instance, primarily to the application of the uniqueness of occupational therapy to the role of the OT in schools. Becoming familiar with community resources, services and contact persons; knowing how to move through the system effectively. Acquiring skills needed to function as a team member and consultant; being able to share one's knowledge with other professionals. Having a knowledge base about the family: ecosystems, managerial theory, decision-making, home as a learning environment and factors which influence home learning, human resource development, family developmental tasks and stages, and how to assess coping ability. Having a good understanding of the characteristics of the school handicapped population: the severely multiply impaired and others; knowing how to assess students in all areas and having a variety of disabling conditions; knowing how to write performance objectives for indivi- dualized educational plans and how to set priorities for treatment when several goals are presented. Familiarity with union politics and professional liability; knowing how to influence the legislative process regarding the writing of rules, regulations and guidelines. 67 9. Having skills in administration, program development and implementation. 10. Taking responsibility for one's practice without the reliance on a doctor's prescription; becoming an independent practitioner. One of the reasons school personnel question the scientific basis of occupational therapy is a lack of documented evidence that what therapists do makes a difference. Although in some instances there are facts which can show that therapy did influence change, often it is difficult or impossible to show research to back up certain treatment modalities. The present emphasis on sensory-integrative treatment which has reached the certification stage, needs more re- search to give validity to treatment techniques. Though OTs claim to help the learning disabled improve cognitively, a sound research base is needed to provide data to confirm this claim. PL 93-222: Health Maintenance Organization Act of 1973101 lpggpt; As costs of medical care rose and consumers of health services found it difficult to pay for unexpected medical expenses, the federal government decided to change the emphasis on acute care to prevention of illness through pre-paid health plans. The intent of this legislation was to keep people out of hospitals by keeping them well. Provisions: This law established the requirements and restric- tions for Health Maintenance Organizations (HMOs) which could provide prepaid health services to the well consumer, as well as intermediate and long term care if such is desired by the enrollee. 68 Scope of Service: The role of the OT in an HMO is a preventive care one. Preventive medicine deals with the quality of life and the interdependence of people, and acts to limit health problems 102 Emphasis areas in a prevention and the stress arising from them. to adaptation continuum are promotion or health education; protection or the interception of illness and injury agents and conditions; identification through recognizing health deviations; correction by treating or rehabilitation; and accommodation through the adapta- tion of a person with the illness or health limitations.103 Since OTs believe in a health-illness-health concept, an emphasis on wellness or prevention is compatible with practice. Although there is no provision in this legislation for funding of the OTs services, there are other sources for payment of services such as the HMO, or private payment for the therapist's independent services (less likely since the consumer has already paid for all services through the HMO). The importance of this Act is that it implies a shift in total health care emphasis from the hospital dis- ease-oriented model to one of prevention, which intrinsically involves all people, health practitioners and community agencies. Responsi- bility for maintaining one's health becomes each individual's, with health professionals taking on an educative, supportive role. As preventive health care extends beyond the hospital and clinic to the home and community environment, the OT's one-to-one treatment role shifts to teaching, consulting, program development and/or re- search. As health agent the OT has "progressed from technician re- ceiving a prescription from the physician to our present position as principle agent in the treatment of patients who require an intervention process employing the therapeutic use of activities. 69 "104 What is required of the therapist who assumes or defines this new role? According to Finn, there are several needs: 1. An understanding of the meaning of health that is more encompassing than the absence of disease. Knowledge about the community systems, the health center (the HMO), or the industrial setting. Interpretation of the OT body of knowledge, particularly the relationship of activities in an environment to the maintaining of a sense of health. Thinking creatively, so that our knowledge of occupational performance becomes functional material for developing prevention programs in the service of maintaining health. This premissed on our knowledge of people's needs. Coping need of an unfamiliar situation to develop new skills in interpersonal relationships, increased sensi- tivity to the behavioral cues of others. These are necessary given non-medical and institutional environment. Deve10ping a new communication process which allows the OT to talk understandably to Clients and others who are not medically oriented, and put into simple language con- cepts that have been learned and subsumed under the mantle of the professional term. Having the patience to spend a lot of time planning the service to be offered; then be able to explain and defend and revise. Creating a Climate of acceptance for an individual's or client's program. OTs individually and collectively, according to Finn, tend to wait for cues to act. In preventive health maintenance, as in other settings where the role is new, the therapist must assume an active dynamic role. Stein discusses several areas of primary prevention in which an 0T can practice: 1. 105 Private industry - to prevent industrial accidents, occupational diseases and recognition of hazardous conditions. Relating activities to normal development and conse- quences for parents and health workers. Architectural design. 7. 70 Research on relationship between activity and lessening of hypertension to prevent heart disease. Study the effects of activity programs for aged people to prevent senility. Maternal health care; interdisciplinary research on birth defects. Early intervention in developmental disabilities. Educational and Research Implications: There are many. The study of activity and the application of this knowledge to the pro- vision of a better way of life is basic to occupational therapy. To shift focus from the value of a specific activity to achieve a desired result, to the total life situation requires a more compre- hensive understanding of activities and human action. Other impli- cations are the following: 1. Acquiring leadership skills for community involvement, including communication abilities. Learning more about social effects of technology on the quality of life; the economic, political and social forces that control individual goal attainment and influence family decisions about the use of resources and management of family life. Applying knowledge of developmental life stages and tasks to the prevention of crises. Learning enough about human behavior and how and why change occurs to be able to motivate people to “do something to prevent what does not exist", as in prevention. Educational programs in occupational therapy will need to find field work settings in community placements where practice in this new role can be done. 71 The greatest need for the profession is to stress doing research on the dynamics of occupation, establish norms for different ages, cultures, sexes; consider the relationship of lack of activity to quality of life; the relationship of the tolerance of stress jobs as a health intrusion to the nature of that stress. OTs should study behavior in terms of the use of occupation and its influence on health. In no other arena of practice is there such a strong need for doing research in order to validate the ensuing practice. PL 93-641: gggtional Health Planningyand Resources Development Act of 1974 lgggppz This law sets equal access to quality health care at a reasonable cost as a national priority, according to the preamble to PL 93-641. The intent of this law is to establish guidelines for health planning and resource allocation within states so that ultimately everyone will be able to receive quality health care at a reasonable cost. Provisions: Growing out of a need to coordinate several earlier health planning and public health acts, this Act of 1974 proposed to affect health care through providing uniformity in health delivery methods and mal-distribution of health resources (both manpower and facilities), and to alleviate the increasing costs of health care.107 Health Systems Agencies (HSAs) were established in states, functioning under a statewide Health Coordinating Council. Health Systems Plans (HSPs) were mandated; their goal being to assure quality health ser- vices which would be available at a reasonable cost for all residents. Representatives on the Agency and Council boards were required to come from consumer and service health groups, of which OTs were 72 included as Allied Health Professionals. Issues related to preven- tion of disease, preventive health care services, public health edu- cation and primary care to underserved populations were among those for which policy and standards would be developed. In essence this law modified and enhanced the role of technology in regional planning. Characteristics of plan development are national health planning policy, national priorities, a common health system framework, concern for cost containment, detailed data analyses and cost-benefit analysis. Scope of Service: For OTs this law offers an opportunity to participate in the health planning process through membership on the HSA or the statewide council, or indirectly by maintaining a liaison with the allied health representative who sits on the Board of the HSA so that a channel of communication for exchange of concerns of mutual interest will exist. If the intention of this law is realized, the presence of OTs who can articulate the profession's needs and contributions is of great importance. OTs can inform the council about the scope and variety of services available by OTs; contribute to planning recommendations for the allocation of resources such as funds to be spent on the construction of an outpatient clinic versus supporting increased provision of home health service.108 When discussions center around the annual implementation plan which includes giving priority to objectives, OTs can provide factual infor- mation about the benefits of early intervention services for children with developmental disabilities as opposed to the costs of inter- vening at a much later date; the benefits of providing rehabilitation of persons to an independent living status versus the cost of main- taining persons at home on supplemental security income and medicare; 73 the benefits of providing home health services of an OT for chronic disabilities instead of providing financial support to such conditions in nursing homes. Sitting on a Council or Agency Board is obviously not a working function which offers compensation financially. It does, however, suggest a way for OTs to influence the system through involvement in planning. Educational and Research Implications: To provide support for the role of occupational therapy in various settings, studies are needed that document the fact that OTs do, in fact, contribute meaning- fully to the outcome of the treatment. In the absence of such evi- dence, the need for research and involvement in quality care studies becomes evident. Only through this kind of "proof" can OTs state unequivocally that costs of their services are justified. Implications for education are the following: 1. Acquisition of professionalism over and above the technical skills obtained in the educational program. 2. Knowledge of evaluation methodology, quality care review, administrative cost-benefit analysis. 3. Knowledge of the planning process, including gathering appropriate data, relating goals to objectives, setting priorities and implementing action. 4. Acquiring familiarity with this Law and other legislation pertinent to OTs, and learning how to assume a proactive role: "responsible participation, not a silent partner- ship, is the key to improving public relations and furthering professional objectives."109 74 5. Developing communication skills that are effective and precise; having the ability to convey the uniqueness of occupational therapy concisely and simply; knowing generally how OTS serve the whole community. 6. Possessing evaluation skills for doing valid research using patient care studies. 7. Developing the ability to analyze skillfully, maintain a broad perspective of the total situation, and involve- ment in research critiquing and participation. PL 92-603: Social Security Amendments of l972109 lptgggi The intent of medicare legislation has been to regulate the distribution of health services within the program and to protect the quality of health care. Provisions: This Law called for the creation of Professional Standards Review Organizations (PSROs) which are intended to "promote the effective, efficient and economical delivery of health care ser- vices of proper quality."110 Although previous legislation had estab- lished peer review, chart auditing, utilization review and other measures to assure quality health care, the Congress felt that there had been little impact on the quality or economy of health care. The profession of occupational therapy has expressed concern for quality care through accreditation of schools, certification of thera- pists through examination, standards of practice, continuing education programs and a recertification program. The PSRO system operates through national, state and local systems and includes on the councils both physicians and other health care 75 practitioners. Review studies are required: concurrent, retrospec- tive, and analysis of hospital, practitioner and patient profiles. The law obligates OTs to participate in chart audit and to be involved in the PSRO process because it is a reimbursable service under Medi- care and Medicaid. Scope of Service: OTs working in hospitals, clinics and nursing homes are required by the Law to become involved in PSRO. Among the various kinds of participation is the profiling or profile analysis which focuses on patterns of service that require modifications, provides a means for self-evaluation and comparative evaluation of facilities and practitioners. The information from profiling is used by PSROs to monitor the impact of the review process and to compare the overall effectiveness of the program. Other kinds of participation are in Medical Care Evaluation studies which require a knowledge of evaluation techniques and metho- dology; patient care audit and the development of process and outcome standards. Peer review is also useful among OTS as a method for identifying educational needs of therapists. Educational and Research Implications: OTs are challenged in all practice settings to be accountable for services rendered in order to be able to contribute to cost-benefit analysis and cost containment. Educationally this demands a knowledge of business practices which contribute to accountability. The implications of involvement in quality care review processes are the following: 1. Knowing how to perform cost-benefit analysis; how to evaluate the outcomes of client services in relation to the treatment performed. 76 2. Being skillful in all forms of evaluation methodology, documentation, written and oral communication. 3. Being actively involved in the entire PSRO process as leaders. 4. Having an awareness of the total health care picture in one's own institution, as a part of a community system of interacting and interdependent persons and places (ecological approach). 5. Knowing how to do research studies - case studies and action research. Social policy legislation which affects the practice of occupa- tional therapy has been reviewed in two community systems: schools and vocational rehabilitation; in an emerging practice dimension: prevention; in health care planning, and quality care review. Numerous implications for skills, knowledge and attitudes have been suggested, some of which are being taught in occupational therapy educational programs, and some which are not included. A summary of these compe- tencies are included in the Appendix. Research Methodology The review of research methodology covered competency studies done in other professions with primary emphasis on the methods and procedures used to identify and validate competencies. A study was done by Howard111 to identify and validate change agent competencies. A three-phase methodology was used to accomplish the objectives of the study. Phase one consisted of a survey of the literature relative to change agent roles and duties in education. Second, a pilot study 77 to identify the most important competencies that would have relevance to the final investigation, was done. The third phase focused on empirically validating those competencies which were identified from the pilot study. Change agent roles were selected from the literature review. The data collection instrument had 105 competency statements which were validated by a group of 53 reviewers. From this pilot study a 37-item list was presented to 272 reviewers. Validation was com- puted statistically among the demographic variables and the change agent competencies. 112 completed a study of the assessment of the leadership Mokma role in emerging career education programs in Michigan. The litera- ture review covered, among several topics, the analysis of roles for determining curriculum content. This approach was called the "function-activities" approach by Clark and Meaders in 1968. Once identified, these activities or tasks then serve as a basis for identifying specific competencies - skills, knowledges, and atti- tudes needed by personnel occupying the particular occupation. Others used this approach in vocational education while Heilman used func- tions as a method for organizing and grouping tasks and activities after they were identified. 113 outlined six steps for developing a program of McCleary competency-based administration: 1. Assess competency needs. 2. Specify competencies. 78 3. Determine competency components and performance levels. 4. Identify competency attainment. 5. Establish assessment of competency attainment. 6. Validate competencies, attainment procedures and assessment system. The procedures used in this study consisted of role analysis methodo- logy. An instrument was developed after the review of the literature for functions in leadership roles. Next, critical incidents were created to reflect each function. Eight leaders were selected to be representative of the study population; interviews were conducted; 46 activities were identified. A panel of judges reviewed the list which was then incorporated into an instrument which was pilot- tested with a group of 10 career education persons. The instrument was revised and sent to 60 superintendents. From their responses the data was analyzed and the results tabulated. Competency-based professional education in Home Economics began with the development of competencies and criteria at a national 114 After the working clinic at Kansas City, February 7-10, 1977. subject matter competency lists were assembled, they were validated by Circulating them to three or four specialists in each of the five areas of the United States. After review by the specialists, committee members incorporated their suggestions into the present materials. The Dieticians have also developed a CBE educational program. In 1974-75 a set of entry-level competencies were selected from a 79 Study Commission, American Dietetics Association's Plan IV and other documents. Competencies (85) covering Foodservice, Clinical Nutri- tion and General were selected. They were validated by questionnaire, critical incident technique and interview and observation. Question- naires were sent to MSU faculty (25), dietetics practitioners (77), MSU Foodservice practitioners-educators (18), dietetic educators in the 0.5. (45), and significant others (non-dietetic, 28). The second questionnaire had 108 items and was sent to the same people. The third questionnaire had 445 competencies stated at four different levels of difficulty based on Bloom's Taxonomy. These were sent to 233 with the addition of 62 recent graduates. Critical incidents in work were reported; interviews followed which revealed gaps in identified competencies. The following roles were identified: com- municator, facilitator, educator, manager, advocate and professional. The Delphi Procedure The Delphi procedure has been used extensively to seek opinions about important issues. A study of the knowledge and skills for the adult educator, a Delphi study, was done by Rossman and Bun- 115 This study utilized a series of four questionnaires. The ning. first solicited open-ended responses to the basic question. The second asked respondents to prioritize the statements generated by the first questionnaire on a 5-point rating scale. The third fed back the modal consensus of the previous respondents and asked them to either join the consensus or defend their dissent with indi- vidual statements. The final questionnaire asked respondents to Choose learning experiences which would be most appropriate for 80 the adult educator to acquire the knowledge and skills rated as "highest priority" on questionnaire three. The Delphi procedure was also used in a study done by Young at Michigan State University, on the development of a family studies program at the college level.116 One of the purposes of the study was to contribute to the theory of the Delphi method by comparing panels that have hierarchical, heterogeneous, and homogeneous sections, within specialist and generalist groups. A 15 member advisory commit- tee evaluated the objective and pilot tested the questionnaire com- pleted by 104 persons in six Delphi panels. Round One contained 123 items derived from the review of the literature. Panelists' suggestions were added in round two and information and evaluation items in round three. A four-point Likert-type scale was used as a metric. Statistics reported to panelists were median and inter- quartile range. Round three data were submitted to principal factor analysis with varimax rotation, two-way analysis of variance and Newman-Keul one-way analysis of variance. The Uhl formula was used to test convergence to consensus. Results of the study showed that the Delphi method was suitable for the development of a program in family studies at the college level. Convergence to consensus on objectives and formal content topics was complete by round two, and informal content topics by round three. There were sufficient differences in the panels to warrant continued research on specialist and generalist groups with all three sections. Although the Delphi method was originally used to forecast, it is increasingly used to resolve conflicting Opinion and to determine policy in complex situations. Young reviewed the 81 research on the Delphi method, considering its history, purposes, philosophy, process, modifications, advantages and disadvantages. 117 noted that historically the Delphi method was developed Helmer from forecasting operations research in World War II. It was design- ed to obtain group opinions without face-to-face confrontation. Young says that it is an effort to produce convergence of group consensus through a series of three or four questionnaires dealing with future-oriented questions.118 Modifications to the method have been classified as selection of the panel of experts, format, number of and interval between rounds. Young found that in 49 dissertations reviewed, 34 used three rounds. Criteria for selection of experts was listed by Helmer and 119 level of knowledge of the person about the topic; degree Rescher: of reliability, determined by the relative frequency of accurate predictions already made by the person. In essence, the character- istics of the panel of experts should be matched to the nature and purposes of the study. Advantages of this method over assembling experts were the following: 1. Less costly (if experts were to be gathered from some distance). 2. Avoids persuasion, leadership influences, hidden agendas, personality conflicts and other problems of group decision-making. 82 3. Several studies showed the Delphi to have remarkable accuracy. 4. Provides documentation of a precise nature, including minority opinions. Disadvantages are the critical problems of predicting the future; bias can be present in the selection of the panels; and much time can be Spent in completing the series of questionnaires. In summary, the Delphi method with modifications appears to be a suitable way to obtain opinions of persons on the competencies identified in this study. Survey Methodology Since a survey instrument was used in this study, a review of survey methodology as a research tool was completed. The sample survey is an appropriate and useful means of gathering information under three conditions: when the goals of the research call for quantitative data, when the information sought is reasonably specific and familiar to the respondents, and when the researcher has consider- able prior knowledge of particular problems and the range of responses likely to emerge.120 Survey research is probably the best method available to the social scientist interested in collecting data for purposes of describing a population too large to observe directly.121 Babbie goes on to say that careful probability sampling provides a group of respondents whose characteristics may be taken as represen- tative of those of the larger population. There are both strengths 83 and weaknesses incumbent in survey research. Strengths are the following: 1. Makes very large samples feasible which is important for descriptive and explanatory analysis. Useful in getting opinions of large populations scattered geographically. Flexible because much information can be obtained. Because the same questions are asked each person, there is strength to measurement generally. Since there are no real meanings to a concept, asking each person the same questions allows the researcher to impute the same intent to all respondents giving a particular resonse. Economy and standardization are possible as compared to interviews. There is a lack of interviewer bias in the self- administered questionnaire. Weaknesses of survey research can be summarized as follows: 1. Generally a researcher seldom taps what is most appropriate to many respondents by designing questions that will be at least minimally appropriate to all respondents. Trends to be superficial by comparison with inter- viewing since the research can seldom deal with the content of social life or develop the feel for the total situation. 84 3. Although flexible in one sense (amount of infor- mation that can be obtained), surveys require that an initial study design remain unchanged throughout the entire research. 4. There is an artificiality inherent in experiments or surveys. Since surveys cannot measure social action, they can only collect self-reports of opinions at a given time. The act of studying a given topic may affect the respondents' opinions. Based on the sampling techniques used, survey research can have generalizability to dispersed populations and larger populations within known limits of error. Replicability is possible because the measuring instruments and conditions of research are arranged so that they can be repeated. It must be remembered that every method of data collection, including the survey, is only an approximation to knowledge.122 In this chapter competency-based education has been discussed with advantages and disadvantages stated. The review of occupational therapy literature included the AOTA Essentials, philosophy principles and theory of occupational therapy, educational areas, emerging competencies and opinions of leaders of the profession. Social policy legislation review covered five public laws related to health care. Research methodology related to identification of competencies, the Delphi Procedure and survey methodology completed Chapter 11. Chapter III will contain the methodology and data collection procedures. 85 Footnotes 8Pottinger, Paul S. and Goldsmith, Joan. Definipgand Measuring Competence. California: Jossey-Bass Publishing Company,l979. 9Roberts, M. Diane, Cordova, David, and Saxe, Ellen. "A Process Model for Competency-based Education," American Journal of Occupational Therapy, XXXII (July, 1978), 369-374. 10Del Bueno, Dorothy J. "Competency Based Education," Nurse Educator (May-June, 1978), lO-l4. nHouston, W. Robert and Howsam, Robert B. Competency-Based Teacher Education. Chicago: Science Research Associates, Inc., 1972, p 3. 12Davis, Robert H., Alexander, Lawrence T., and Yelon, Stephone L. Learning System Desigp. New York: McGraw-Hill Book Company, 1974. 13Elam, Stanley in Blank, William E. "New Delivery System for Effectiveness," American Technical Education Association Journal (September-October, 1978). 14Browder, Lesley H., Atkins, William A., and Kaya, Esin. Developingpan Educationally Accountable Program. California: McCut- CHan PubliShing Corporation, 1973. 15Nyquist, Ewald 8. "Measuring Purposes and Effectiveness,“ in Accountability in Education, edited by Lessinger and Tyler. Ohio: Charles A. Johns Publishing Company, 1971. 16Lessinger, Leon M. "Accountability for Results: A Basic Chal- lenge for America's Schools, “ in Accountability in Education, edited by Lessinger and Tyler. Ohio: Charles A. Jones Publishing Company, 1971. 17Del Bueno, Dorothy J. "Competency Based Education," Nurse Educator (May-June, 1978), 10-14. 18Roberts, M. Diane, Cordova, David, and Saxe, Ellen. "A Process Model for Competency-based Education," American Journal of Occupational Therapy, XXXII (July, 1978), 369-374. '91bid., p. 371. 20Anderson, Robert M., Greer, John G., and McFadden, Susan M. "Providing for the Severely Handicapped: A Case for Competency- based Preparation of Occupational Therapists," American Journal of Occupational Therapy, XXX (Nov.-Dec., 1976), 640-645. 86 21Mayen, E. L., and Altman, R. "Individualizing Instructions for Pre-service Teachers: An Applicable Competency-based Training Model," Focus Exceptional Child, V, 1973, 1-11. 22Anderson, Robert M., Greer, John G., and McFadden, Susan M. "Providing for the Severely Handicapped: A Case for Competency- based Preparation of Occupational Therapists," American Journal of Occupational Therapy, XXX (Nov.-Dec., 1976), 645. 23Barris, Roann. "Competency-based Education and Creative Thinking," American Journal of Occupational Therapy, XXXII (July, 1978). 363-368. 24 25Rogers, Carl in Barris, Roann, "Competency-based Education and Creative Thinking," American Journal of Occupational Therapy, xxx11 (July, 1978). p. 364. 26Hefferman-Caprera, P. “The Potential for Humanistic Endeavor," in Exploring_§ompetency-Based Education, W. R. Houston, Editor. Cali- fornia: McCutChan Publishing Corp., 1974. 27Davies, 1. K. in Barris, Roann, "Competency-based Education and Creative Thinking,“ American Journal of Occupational Therapy, xxx11 (July, 1978). p. 365. Ibid., p. 364. 28Parker, R. in Barris, Roann, "Competency-based Education and Creative Thinking," American Journal of Occupational Therapy, XXXII (July, 1978), p. 366. 29Wilson, Margaret A. "A Competency Assurance Program," American Journal of Occupational Therapy, XXXI (Oct. 1977), 573-579. 30Johnson, Jerry A. "Nationally Speaking," American Journal of Occupational Therapy, XXXI (Oct. 1977), 551-554. 31Pottinger, Paul S., and Goldsmith, Joan. Definingand Measurjpg Competence. California: Jossey-Bass Inc., Publishers, 1979. 32Op cit., Wilson, Margaret A., p. 573. 33Ibid., p. 574. 34Wilson, Margaret. "An Introduction to the Proficiency Examina- tion," American Journal of Occupational Therapy, XXXI (Oct. 1977), 162-168. 35Wilson, Margaret A. "A Competency Assurance Program," American Journal of Occupational Therapy, XXXI (Oct. 1977), 575. 36Op cit. Anderson, Greer, McFadden. p. 645. 87 37Norton, Robert, and Harrington, Lois. Performance-Based Teacher Education: The State of the Art,,Genera1 Education and Vocational Education. GA: American Association for Vocational Instructional Materials. 38Competencies for Home_Economics Teachers by Home Economics Teacher Educators. Iowa: The Iowa State University Press, 1978. 39Wilson, Margaret A. "A Competency Assurance Program," American Journal of Occupational Therapy, XXXI (Oct. 1977), 20. 40Ohio State University, School of Allied Medical Professions. Development of Occupational Therapy Job Descriptions and Curricula through Task Analysis. Reports No. 1-6. COTUmbus, Ohio: The Ohio State University, 1971. 41Project to Delineate the Roles and Functions of Occupational Therapy Personnel, Rockville, Maryland, American Occupational Therapy Association, 1978. 42A Curriculum Guide for Occupational Therapy Educators, American Occupational Therapy Association, Inc., Nov. 1974. 43Occupational Therapy: 2001. Papers presented at the Special Session of the Representative Assembly, November 1978, American Occu- pational Therapy Association, 1979. 44Weimer, Ruth. "Traditional and Nontraditional Practice Arenas," irlOccupational Therapy: 2001. American Occupational Therapy Associa- tion, 1979. 45Certificate of Incorporation of the National Society for the Promotion of Occupational Therapy, Inc., Clifton Springs, New York, March 15, 1917, in Weimer, Ruth, "Traditional and Nontraditional Practice Arenas," Occupational Therapy: 2001. American Occupational Therapy Association, 1979, p. 43. 46"Training of Teachers for Occupational Therapy for the Rehabili- tation of Disabled Soldiers and Sailors." Federal Board for Vocational Education, Bulletin No. 6, Government Printing Office, 1918, issued in response to Senate Resolution No. 189 and transmitting to the President of the U.S. Senate a study by the Federal Board for Voca- tional Education 1/28/18 entitled "The Rehabilitation of Disabled Soldiers and Sailors, and the Training for Occupational Therapy," (study made by Elizabeth G. Upham), p. 13. 47West, Wilma. "Historical Perspectives," in Occupational Therapy: 2001. American Occupational Therapy Association, 1979, p. 10. 48Gillette, Nedra, and Kielhofner, Gary. "The Impact of Speciali- zation on the Professionalization and Survival of Occupational Therapy, American Journal of Occupational Therapy, 33, l, p. 28. 88 49Hopkins, Helen, "An Historical Perspective on Occupational Therapy," in Hopkins, Helen and Smith, Helen (eds.), Willard and Spackman's Occupational Therapy, 5th edition, New York: J. B. Lippin- cott Co., T978. 50 51 Ibid., p. 12. Ibid., p. 28. 52A Curriculum Guide for Occupational Therapy Educators, American Occupational Therapy Association, Inc., November 1974, p. 8. 53Ibid., p. 8. 54Needs Assessment, Re-Entry Project, Western Michigan University, unpublished report, July 1979. 55Llorens, Lela A., and Adams, Sandra P., "Learning Style Pre- ferences of OT Students," American Journal of Occupational Therapy, 32, (March, 1978), p. 161. 56Silva, Dolores. "Components in Program Development," American Journal of Occupational Therapy, 30 (October, 1976), p. 568. 57Silva, Dolores. "John Dewey: Implications for Schooling," American Journal of Occupational Therapy, 31, (January, 1977), p. 40. 58Jantzen, Alice. "A Proposal for Occupational Therapy Education," Amergcan Journal of Occupational Therapy, 31 (November-December, 1977 , p. 660. 59Ford, Lana. "Academic and Clinical Exposure to the Field of Mental Retardation," American Journal of Occupational Therapy, 27 (October, 1973), p. 403. 60Nord, Lynn. "An Interdisciplinary Educational Program for Occupational Therapy and Physical Therapy Students," American Journal of Occupational Therapy, 27 (October, 1973), p. 404. 61Christiansen, Capt. Charles. "Attitudes of Graduates," American Journal of Occupational Therapy, 33, (July, 1975), p. 352. 62Eliason, Marian L., and Gohl-Giese, Azela. "A Question of Professional Boundaries: Implications for Educational Programs," American Journal of Occupational Therapy, 33 (March, 1979), p. 63Fidler, Gail. "Specialization: Implications for Education," American Journal of Occupational Therapy, 33 (January, 1979), p. 34. 64Barris, Roann. "Competency-based Education and Creative Think- ing," American Journal of Occupational Therapy, 32 (July, 1978), p. 363. 89 65Roberts, M. Diane, Cordova, David, and Saxe, Ellen. "A Process Model for Competency-based Education," American Journal of Occupational Therapy, 32 (July, 1978), p. 369. 66Allen, Anne Stevens, and Cruickshank, Donald. "Perceived Prob- lems of Occupational Therapists: A Subject of the Professional Curri- culum," American Journal of Occupational Therapy, 31 (October, 1977), p. 557. 67Anderson, Robert, Greer, John, and McFadden, Susan. "Providing for the Severely Handicapped: A Case for Competency-Based Preparation of Occupational Therapists," American Journal of Occupational Therapy, 30 (November-December, 1976), p. 640. 68Cromwell, Florence, and Kielhofner, Gary. "An Educational Strategy for Occupational Therapy Community Service," American Journal of Occupational Therapy, 30 (November-December, 1976), p. 629. 69Ethridge, David A. "The Management View of the Future of Occu- pational Therapy in Mental Health," American Journal of Occupational Therapy, 30 (November, 1976), p. 623-628. 70 Ibid., p. 525. 71Johnson, Jerry. "Nationally Speaking," American Journal of Occupational Therapy, 30 (November, 1976), p. 619-621. 72Johnson, Jerry. "Challenges Confronting Occupational Therapy," Canadian Journal of Occupational Therapy, (September, 1977), p. 113- 117. 73Lewis, S. "Occupational Therapy and Geriatrics: Assuming a Leadership Position," in Nationally Speaking, American Journal of Occupational Therapy, 29 (September, 1975), p. 459-460. 74Shore, Herbert. Needed Now - A Public Policy in Long:Term Care, Part I, hrp 0023978/OGA, 1976. ~ 75Katz, Sidney, Ford, A. B., Downs, T. D., Adams, Mary, and Rusky. "Effects of Continued Care," Department of HEW Publ. #(HSM) 73-3010, December, 1972. 76Ford, A. B., Katz, Sidney, Downs, T. D., and Adams, Mary. "Results of Long Term Home Nursing: The Influence of Disabilities," Journal Chronic Diseases, 24 (1971), p. 591-596. 77Cromwell, Florence, and Kielhofner, c. H. "An Educational Strategy for Occupational Therapy Community Service," American Journal of Occupational Therapy, 30 (November, 1976), p. 629-633. 78Marnio, N. A. "Discovering the Lifestyle of the Physically Disabled," American Journal of Occupational Therapy, 29 (September, 1975), p. 475-478. 90 79Woodside, Harriet. "Basic Issues in Occupational Therapy Edu- catipn Today," Canadian Journal of Occupational Therapy, 44 (March, 1977 , p. 9-16. 80Maxwell, James D. "The Queen's University Study of Occupational Therapy: Some Reflections and Conclusions," Canadian Journal Of Occupational Therapy, 44 (September, 1977), p. 137-139. 81Mosey, Anne Cronin. "An Alternative: The Biopsychosocial Model," American Journal of Occupational Therapy, 28 (March, 1974), p. 137-140. 82Dunning, Helen. "Environmental Occupational Therapy," American Journal of Occupational Therapy, 26 (September, 1972), p. 292-298. 83Weimer, Ruth. In Occupational Therapy: 2001 A.D., American Occupational Therapy Association, 1979. 84Hightower-Vandamm, Mae D. In Occupational Therapy: 2001 A.D., American Occupational Therapy Association, 1979. 85Johnson, Jerry. In Occupational Therapy: 2001 A.D., American Occupational Therapy Association, 1979. 86Cromwell, Florence. In Occupational Therapy: 2001 A.D., American Occupational Therapy ASsociation, 1979. 87Ibid., p. 39. 88Yerxa, Betty. In Occupational Therapy: 2001 A.D., American Occupational Therapy Association, 1979. 89Gillette, Nedra. In Occupational Therapy: 2001 A.D., American Occupational Therapy Association, 1979. 90 1974. 91Congressional Record, October 14, 1978: H 13469, Conference Report on HR 12467, Reabilitation, Comprehensive Services, and Develop- mental Disabilities Amendments Of 1978. 92Public Law 94-142, Education for All Hanicapped Children Act of 1975, issued August 23, 1977. Task Force on Target Populations of the Representative Assembly, 93Public Law 93-222, Health Maintenance Organization Act Of 1973. 94Public Law 93-641, National Health Planning and Resources Develop- ment Act Of 1974. 95Public Law 92-603, Social Security Amendments of 1972. 96Public Law 93-112, the Rehabilitation Act Of 1973. 91 97Hightower-Vandamn, M. 0. Presidential Access in Nationally Speaking, American Journal Of Occupational Therapy, 32 (September, 1978), p. 552. 198Public Law 94-142, Education for All Handicapped Children Act of 975. 99Ibid. 100Ibid. 101Public Law 93-222, Health Maintenance Organization Act Of 1973. 102Weimer, Ruth. "Some Concepts Of Prevention as an Aspect Of Community Health," American Journal Of Occupational Therapy, 26 (Janu- ary-Feburary, 1972), p. 1. 103Ibid., p. 4. 104Finn, Geraldine. "The Occupational Therapist in Prevention Programs," American Journal of Occupational Therapy, 26 (March, 1972), p. 62-66. 105Stein, Frank. "Nationall Speaking," American Journal Of Occupa- tional Therapy, 31 (April, 1977 , p. 226. 106Public Law 93-641, National Health Planning and Resources Develop- ment Act of 1974, from Baselines for Setting Health Goals and Standards, Department Of Health, Education and Welfare (DHEW Publication NO. (HRA) 77-640). 107Larson, Lon N., and Meisel, Karen L. "Health Policy and Planning: Public Law 93-541," American Journal of Occupational Therapy, 32 (April, 1978), p. 229-233. 108Wilson, R. 5. "Health Planning: An Opportunity for Involve- ment of Occupational Therapists," American Journal of Occupational Therapy, 30 (March, 1976), p. 214-215. logKamp, L. "Review Of HSPs Needed," OCCUPATIONAL THERAPY NEWS- PAPER, December, 1977. 110Ostrow, Patricia C. "Professional Standards Review Organi- zation," in Nationally Speaking, American Journal Of Occupational Therapy, 28 (July, 1974), p. 333-340. 111Howard, John. "The Identification and Validation Of Change Agent Competencies," unpublished dissertation, Ohio State University, 1978. 112Makma, Arnold Lee. "An Assessment Of the Leadership Role in Emerging Career Education Programs in Michigan," unpublished disser- tation, 1975. 92 113McCleary, Floyd E. "CBE Administration and Applications to Related Fields," Paper presented to Conference on Competency-based Administration, Arizona State University, 1973. 114Competencies for Home Economics Teachers by Home Economics Teacher Educators. Iowa: The Iowa State University Press, 1978. 115Rossman, Mark H., and Bunning, Richard L. "Knowledge and Skills for the Adult Educator: A Delphi Study," Adult Education, 28 (#3, 1978). p. 139-155. 116Young, Wanda. “Family Studies Program Development at the College Level: A Delphi Study," unpublished dissertation, Michigan State University, 1977. 117Helmer, Olaf. Analypjs of the Future: The Delphi Method, Santa Monica, California: Rand Corporation, March, 1967, p. 7-36. 118Young, Wanda. "Family Studies Program Development at the College Level: A Delphi Study," unpublished dissertation, Michigan State University, 1977. 119Helmer, Olaf, and Rescher, Nicholas. "On the Epistemology of the Exact Sciences," Management Science, 6 (October, 1959), p. 43. 120Warwick, Donald P., and Lininger, Charles. The Sample Survey: Theory and Practice. New York: McGraw-Hill, 1975. 121Babbie, Earl R. The Practice Of Social Research. California: Wadsworth Publishing Company, 1975, p. 259. 122Warwick, Donald P., and Lininger, Charles. The Sample Survey: Theory and Practice. New York: MCGraw-Hill, 1975. Chapter III METHODOLOGY AND DATA COLLECTION The purpose of this study was to identify the competencies needed by occupational therapists to practice in the 1980's. This chapter introduces the methodology and data collection procedures used to fulfill the purpose by including the type Of study conducted, the Objectives, related research questions and hypotheses, and the three phases Of the methodology. Type of Study This study used the Delphi procedure for empirically validating the competencies identified through the literature review. Although not "pure descriptive research which provides information and data "123 this to assist decision-makers in solving a particular problem, study went one step further by Obtaining Opinions of a panel of experts through two surveys. The Delphi procedure will be described under Phase 3 in this chapter. Objectives The following Objectives were germane to this study: 1. To define the competencies needed by occupational therapists. 93 94 2. To validate by Obtaining consensus of members of the profession as to the ESSENTIAL, SUPPLEMENTARY and EMERGING competencies needed by occupational therapists. 3. To derive an educational model for lifelong professional development from the data analysis. From these Objectives the following research questions and hypo- theses were generated: Research Question #1 What are the ESSENTIAL Competencies needed for entry into the profession Of occupational therapy as perceived by a Delphi panel of professionals in the field? Operational Definition: The ESSENTIAL Competencies will be those competencies which the panelists rank as essential or absolutely essential (3.5 - 5.0). The numbers indicate a ranking on the response scale in the INVENTORY. Panelists Competencies Fellows and Curriculum Directors Recent Orgdagge:1(1975 and 1978) ESSENTIAL Group #2 HYPOTHESES H0: There will be no meaningful divergence from the EXISTING ESSENTIAL Competencies. H1: There will be meaningful divergence from the EXISTING ESSENTIAL Competencies needed for providing indirect client services in occupational therapy. 95 Research Question #2 What SUPPLEMENTARY Competencies may be needed for entry into the profession Of occupational therapy in addition to the ESSENTIAL Competencies, as perceived by a Delphi panel Of professionals in the field? Operational Definition: The SUPPLEMENTARY Competencies will be those which the panelists say are minimally or probably essential (1.5 - 3.4). The numbers indicate a ranking on the response scale in the INVENTORY. Panelists Competencies Fellows and Curriculum Directors Group #1 Recent Graduates (1975 and 1978) SUPPLEMENTARY Group #2 Research Question #3 What are the EMERGING Competencies which OTs need to practice in settings other than the traditional general and mental hospitals and rehabilitation centers, such as in schools, homes, residential care facilities, health agencies and other community locations, as perceived by a Delphi panel of professionals in the field Of occupational therapy? Operational Definition: The EMERGING Competencies are those derived from a review Of occupational therapy and other relevant literature, and social policy legislation, and which are not now a part of the AOTA Essentials. These will be all competencies ranked as minimally tO absolutely essential (1.5 - 5.0), excluding the AOTA Essentials. 96 Panelists Competencies Fellows and Curriculum Directors Group #1 Recent Graduates (1975 and 1978) EMERGING Group #2 Research Question #4 What degree Of consensus is there across members of the profession regarding the ESSENTIAL, SUPPLEMENTARY, and EMERGING Competencies? Panelists Competencies Fellows and Curriculum Directors ESSENTIAL AND SUPPLEMENTARY Recent Graduates (1975 and 1978) EMERGING HYPOTHESES H0(l): There will not be convergence to consensus on over 50% of the ESSENTIAL and SUPPLEMENTARY Competencies. H1(l): There will be convergence tO consensus on over 50% of the ESSENTIAL and SUPPLEMENTARY Competencies. H0(2): There will not be convergence to consensus on over 50% Of the EMERGING Competencies. H](2): There will be convergence to consensus on over 50% of the EMERGING CompetenCIeS. Research Question #5 TO what degree do Group One (Fellows and Curriculum Directors) and Group Two (Recent Graduates) agree regarding how essential the various competencies are? Operational Definition: The competencies will be analyzed as to whether they are ESSENTIAL, SUPPLEMENTARY, or EMERGING. 97 Panelists Competencies Group #1 ESSENTIAL Group #2 Group #1 SUPPLEMENTARY Group #2 Group #1 EMERGING Group #2 HYPOTHESES H0: There will be no significant differences between Group One and Group Two regarding how essential the various competencies are. H]: There will be significant differences between these two groups regarding how essential the various competencies are. Research Question #6 DO significant differences exist between the competency scales? Operational Definition: Of the four categories: Education: 1 98 The demographic variables which describe the panelists are identified in the following breakdown for each Bachelor of Arts/Science, Bachelor Of Science in OT, and Certificate in OT. (A) N II II Master of OT (MOT) Graduate Education (not including the MOT) Years in Practice: Work Setting: 1 2 Primary Work Function: 1 1 less than 5 years 2 5 - 10 years 3 11 or more years hospital or rehabilitation center school system, private practice, home health agency, residential care facility, university education program or other. direct client service 2 administration/supervision, consultation, teaching in Class- room or field, and other (in- direct client service) Professional Degree(s) 1 2 3 Years in Practice 1 2 3 Work Setting 1 2 Primary Work Function 1 2 Competencies Scales l - 13 Competencies Scales 1 - 13 Competencies Scales 1 - 13 Competencies Scales 1 - 13 99 HYPOTHESES Professional Degree Ho: There will be no significant difference between educational groups on the competency scales. H]: There will be a significant difference between these groups. Years in Practice H0: There will be no significant difference between years of practice groups on the competency scales. 1: There will be a significant difference between years Of practice groups on the competency scales. Work Setting H0: There will be no significant difference between tradi- tional and nontraditional work setting groups on the com- petency scales. H]: There will be significant differences between these groups. PrimaryyWork Function H0: There will be no significant difference between direct client service groups and indirect client service groups on the competency scales. H]: There will be a significant difference between these groups. Research Question #7 Would OTS take a job in a nontraditional setting, and if so, for what reasons, according to a Delphi panel of professionals? Operational Definition: This question will be analyzed by ob- taining the frequency of responses for each reason for change and 100 by rank ordering the reasons for change. Panelists Reasons for Chapga Fellows and Curriculum Directors Rank order: 1 - 5 Recent Graduates Rank order: 1 - 5 Reasons for Change: to develop own job interest in nontraditional setting desirable client population job available other ... 01-th—1 lllll Design of the Study A three-phase methodology was used to accomplish the Objectives Of this study and to answer the research questions. Phase I The first phase of the methodology identified the competencies needed by OTs to practice. This was accomplished by reviewing the following: 1. The AOTA Essentials, the Ohio University Task Analysis Study124 to Obtain a list of competencies considered by AOTA to be essential for entry into the profession. 2. Social policy legislation having an impact on the profession Of occupational therapy. 3. Literature related to competency-based education; suggestions and recommendations Of leaders in the profession regarding competencies needed for practice. This review Of competencies has been described in Chapter II. The list of competencies generated from the review is included in Appendix A. 101 Phase 2 - Instrument Development and Pilot Testing: This phase Of the study consisted Of designing and pilot testing the OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY (INVENTORY), using the five Fellows Of AOTA who reside in Michigan as pilot testers. Revision of the INVENTORY followed before beginning Phase 3. Phase 3 - Data Collection and Analysis: This phase focused on empirically validating those competencies identified in Phase 1 and 2. For this part Of the study, the Delphi procedure for obtaining Opinions Of a panel of experts was used. The decision to use this procedure was based in part on the review Of the literature. Since the INVENTORY would be a long one, it was decided to use only two rounds for surveying panelists. This modifi- cation Of the Delphi procedure in which three rounds is the most common number, was deemed advisable for the following reasons: 1. Round one contained a long list of competencies for panelists to make judgments about. 2. Since the INVENTORY was long, two rounds were considered to be the greatest number from which responses could be Obtained. Population and Sample The sample for this study was drawn from a population Of approxi- mately 25,000 OTS. Both stratified and systematic random sampling 102 were used to Obtain the strata of the population desired, and to ensure randomization. TO Obtain opinions Of leaders in the profession, all Fellows of AOTA were part Of the sample. Fellows are selected by the profession of AOTA for having made a significant contribution to the continuing education and professional development Of members Of the association. Curriculum directors were Chosen because Of their involvement in the educational process Of OTS. Practitioners who graduated in 1975 were selected because they would have practiced as long as possible and still have gone through school under the AOTA Essentials of 1972. Graduates who took the registration examina- tion in January and June, 1978, were Chosen because they would have practiced at least one year in present practice settings and would have also gone through school after the educational programs had had at least two years to revise curricula to conform to the 1973 AOTA Essentials. The size of the sample was decided in consultation with Dr. Lawrence Lezotte, head Of the Institute for Research on Teaching at Michigan State University. A sample Of 300 was thought to be adequate for establishing a valid Opinion consensus. This number would be apportioned approximately equally among Fellows and Curricu- lum Directors (100) and recent graduates from 1975 (100) and 1978 (100). TO Obtain this number, with consideration given to non- responses, it was decided upon consultation with AOTA'S Operations Research Director, Francis Acquaviva, to sample 300 from each of the two groups Of recent graduates, all Fellows and all Curriculum Directors, including the Occupational Therapy Assistant's program (a grand total Of 842). 103 A systematic sampling procedure was used to Obtain randomization from among the recent graduates. This consisted of starting at a random point in the list and selecting every Kth element (every 7th). This "systematic sample with a random start" according to Babbie125 is virtually identical to simple random sampling if the list Of elements is "randomized" in advance Of sampling. Empirically the results Of simple random sampling and systematic sampling are virtually identical. In systematic sampling care must be given to periodicity Of the elements in the list. This means that if a cyclical list pattern exists, a grossly biased sample may be drawn. In this study the lists Of registered therapists which exist on the AOTA computer are in the order of registration only, thus eliminating any periodicity or cyclical pattern. Data Collection The INVENTORY for Round One consisted of 140 variables Of which 124 were competency statements and 16 were demographic variables. There were 28 pages Of which two were informational. A rating scale Of 5 to 1 with 5 being absolutely essential, 4 - essential, 3 - prob- ably essential, 2 - minimally essential, and l - useful, but not essential, followed each competency statement. Panelists answered the question, "How essential is each Of the following competencies for entry into the profession?" Demographic data consisted of educa- tional degrees, professional development in past year, employment status, number of years worked as an OT, work setting, primary work function and Change Of employment setting. 104 This INVENTORY was sent to all panelists, together with a cover letter requesting each person to be a panelist and complete the INVENTORY. From this number, 302 usable responses were returned. Letters with returned INVENTORIES excused 15 from participating for reasons such as "being out of the profession too long," not practicing directly in an area of occupational therapy, or living out of the country. There were 19 not deliverable INVENTORIES. Table 1 summarizes the responses to the INVENTORY for Rounds One and Two. The INVENTORY for Round Two consisted Of two parts. Part 1 repeated the competency statements from Round One with the addition of clarifying parts to a few (7). Feedback was given to panelists concerning the mean of responses for each statement and a histogram showing the response rate in each of the five rating columns. Those competencies which had obtained consensus Of .77 were indicated, and no response was required to these. A total Of 11 Obtained consen- sus on the first round. The method for determining consensus is described under data analysis. Part 2 of the second INVENTORY contained all the competencies which had been submitted by panelists in Round One. They were listed in each category in the same manner as were the competency statements in Part 1. Panelists were asked to make a judgment about the essen- tiality Of these as well. However, if necessary because Of the length Of the INVENTORY (46 pages) to make a choice between the two parts, it was stressed that Part 1 was critical to the outcome Of the research and should, therefore, be completed first. 105 FF meemeec meeeeewweemwz N enema amen eew — meow eep wmowzm>zH m weep ea emceepem :ewmmewege we pee meow eew m a N ewaaweoo aeowoaoae e ceeaoe we pee zemwwmo eewwez mpmwwmcee eweece>wweo tweeee seem emceepem pez uez memeeemmm —eeew eeeecee we peeecee eeeceuem rmemeeemem eeo eeeem .ezw eee eco meceem Lew >mowzu>zH one e» memceemem .w eweew 106 A cover letter was included with both rounds, a sample of which is included in Appendix C. Follow-up postcards were mailed to panel- ists in both rounds to remind them to return their INVENTORY. This was done approximately three weeks after mailing the INVENTORY. A return postage-paid envelope was included in both rounds to encour- age completion Of the INVENTORIES. In Round One a five-page refer- ence list was included as a motivator to stimulate a desire to respond, reasoning that if the panelist receives something as a gift, there might be a stronger inclination to do something in return. Round One was mailed on January 23, 1980; Round TWO on March 21, 1980. About six weeks was required to Obtain all responses in each round (see Table 2). Table 2. INVENTORY timetable for obtaining and analyzing data. Number Date Pilot testing returned 5 12/17/79 Round One mailed 843 1/23/80 Follow-up cards mailed 2/05/80 Round One data analyzed 3/08/80 Round Two mailed 301 3/21/80 Follow-up cards mailed (AOTA National Conference 4/21/80 intervened) Round Two data analyzed (starting) 5/21/80 107 Data Analysis Since Objective #2 was to validate by getting Opinions from members of the profession as to the essential and supplementary competencies needed by occupational therapists, the data analysis focused on the convergence to consensus. Consensus is defined as the degree to which everyone is in total agreement, as opposed to dispersion, which is the degree to which people are polarized. A measure of ordinal consensus was used, based on the work Of Leik.126 The typical Likert-type question produces an endorsement Of only one Option, with no statement by the respondent regarding other pos- sible options. For this reason no assumptions about the intervals between choices can be made. Therefore, a formula which is a measure of ordinal consensus has tO be used. Leik's formula is the following: 2 Z d] D=m_]-l D is a percentage, a measure of ordinal dispersion; when subtracted from 1 (total consensus) it becomes a percentage Of consensus. 2 d1 equals the cumulative frequency of responses; m equals the number of options in the scale. Other Delphi studies had used the semi-interquartile range as an indicator of consensus, the median and the mean.127 The semi- interquartile range was obtained in this study as a check against the ordinal dispersion formula Of Leik, and the results indicated agreement. An adequate degree of consensus was considered to be .77 or better, using the Leik formula for ordinal consensus. On the semi-interquartile range scale, this was equal to .49. A Fortran 108 program was written to Obtain the statistical analyses needed to Obtain consensus and semi-interquartile range. For both Round One and Round Two the INVENTORIES were coded on optical scan sheets by two coders: the researcher and one assis- tant who read the responses to the other who then checked the circle on the optical scan sheet. Frequent checking for errors was done to maintain accuracy. These sheets were taken to the computer for card punching. The cards were verified as to accuracy and any error was corrected. The mean was given as feedback to the panelists in Round Two since it is a statistical average of responses, easily understood by those reading the competency statements. Multivariate analysis of variance (MANOVA) was done to determine differences between group means on the competency variables. Reliability tests were done to determine variables that did not belong in identified categories. Cross tabulation tables and cross breakdowns of demo- graphic data and the sample groups were also completed. Figure 5 shows the statistical analysis procedures used for the data analysis. Chapter III has included the type Of research study, Objectives, research questions, and hypotheses. From these the study was de- signed, and the three phase methodology determined. The population and sample is described, data collection techniques noted and the data analysis procedures necessary for completion Of the third phase listed and explained. Chapter IV will contain the findings of the study. 109 Figure 5. Summary of data analysis. Purpose Data Used Statistic Feedback to panel- Round One Mean, Frequency, ist to encourage INVENTORY Standard Devia- consensus responses tion and Vari- TO determine convergence to consensus TO determine internal con- sistency of competencies TO determine differences between groups To decide whether to add 17 late responses Rounds One and Two INVENTORIES responses Round One INVENTORY responses Rounds One and Two INVENTORIES responses Round One INVENTORY responses ance Semi-interquartile Range and Leik Formula Coefficient Of Reliability MANOVA, Univariate F Tests, Roy- Bargman Stepdown F Tests Mean 110 Footnotes 123Deabold, Van Dalen. Understandinngducation and Research. New York: McGraw-Hill Book Company, 1966, p. 203. 124Ohio State University, School of Allied Medical Professions. Develppment of Occupational Therapy Job Descriptions and Curricula through Task Analysis. Reports NO. 1-6. Columbus, Ohio: The Ohio State University, 1971. 125Babbie, Earl R. The Practice of Social Research. California: Wadsworth Publishing Company, 1975, p. 259. 126Leik, Robert K. "A Measure of Ordinal Consensus." Pacific Sociological Review, Fall 1966, p. 85-90. 127Young, Wanda. "Family Studies Program Development at the College Level: "A Delphi Study," unpublished dissertation, Michigan State University, 1977. Chapter IV RESEARCH FINDINGS This Chapter contains the results of the analysis Of the respon- ses from the panelists who participated in this study. The Objectives Of this study were accomplished in three phases. Phase I consisted Of the identification of competencies through the literature review. A list Of these competencies and their source is given in Appendix A. Phase 2 involved the deveIOpment and pretesting Of the OCCUPATIONAL THERAPY COMPETENCY INVENTORY. Phase 3 included the data analysis. In this chapter the research findings will be given for each research question. A summary of the responses to the INVENTORY has been given in Chapter III, and in Table 1. There were 17 respondents who returned their INVENTORIES after the initial analysis Of second round data had taken place. TO decide whether these 17 could be included with the responses Of the larger sample of 284, the small group responses were analyzed to determine differences in means Of each competency variable, the standard deviations and variances. Upon comparing the means Of the competencies Of these two groups, none varied more than a hundreth of a point. With this small varia- tion it was deemed permissible to include the 17 with the 284, making a total sample for Round One Of 301. 111 112 Background Of Sample The demographic data which describes the characteristics of the sample which responded to Round One is given in Table 3. This data is taken from the 284 responses which were analyzed prior to receiving the group of 17 that arrived later. The Open-ended respon- ses to employment setting, primary work function and Change Of employ- ment setting are not given because they were so individualized that grouping was impossible. Analysis Of Round One or Round Two Data Since this was a Delphi study which differs from a single survey in that the second round or survey serves as a cross-validation Of panelists' Opinions, the issue arose of whether to use Round One or Round Two data to test the hypotheses. In consultation with the statistical and research consultants, the question Of inferring results to the general population was considered in relation to both rounds. It was thought that Round One data was the more independent, less clouded by interaction with others through the communication process of the Delphi procedure, and therefore more statistically appropriate to use for hypothesis testing. The second round tells the researcher whether panelists are truly committed to their original position after receiving feed- back in terms Of clarifying information about statements, and the histogram showing the frequency of the judgments of others in Round One. To look more deeply into the Delphi process in this study it was decided to use data from both rounds for testing hypotheses 113 cop omp mmH moH we owe NP mow wew>wem ucewwe weecweew eew>wem ucewwe ueewwo eewueeew gee: wmpeee cewpeu -wwweeeoE\_ewwaaoe eeee coeee weueee :ewuepwwweezmw\wepwemex mewpemm weeeaewaEm >mwee=m\ceweecemwewse< eew>wem weewwu peecwo zouhuzau xxo: wespo Eegmeee eewpeoeee zuwmwe>wca prwweew ewee wewpceewmem meemme sawee; wee: eewpeewe epe>wce. Empmxm weesem weueeo :ewpeuwwweesew we weaweme: quhwmm hzmz>o;m2m mm mwemx ewes Le FF mm mwee» ow i m mmw enema m eesu meme ”we ee me eexce: mweea we weesez m oz mmm mm> weeaewese awueemece no» ew< wzmz>oeezm em oz mmm mmw enema ween ecu cw meeeeeeweeo we memweee .meecmxwez :ewueeeee mcweewucee ace cw emueewewuwee so» m>e= wzm:QOAm>mo 4 >3 °I- .C l— >5 m U UWH C) $- +J>PQJU DVDS-+40) M V) m: D O ugcuum m (DOUG) 1— H025 00(1):: >sQHJUGJdJU U Uw-JJ-Hc: .2 Lmo CI—w-U-F-CS-w- _I Q) 'I- Ql>r-I—fU-Hl— 'l- 05E"- P'Ud)>l-°I-> < “- m “"5355 .. 22:3... 53:33.3: 5 Movement 1 2 3 4 5 6 7 8 9 10 1 2 3 Group l-+ Group 2 X X X X X X X 7 Group 2-+ Group 1 X X X X X X X X 10 +-Group l - Group 2 X X X Group 1 - Group 2-+ X X X 168 Table 15. Means of scales. Round One Round Two Scales Total Group 1 Group 2 Total Group 1 Group 2 1 4.075 4.321 3.950 4.070 4.110 4.044 2 4.498 4.647 4.403 4.374 4.506 4.286 3 4.201 4.337 4.124 4.238 4.333 4.177 4 4.077 4.259 3.966 4.l53 4.253 4.089 5 3.621 3.958 3.422 3.791 3.955 3.679 6 3.742 4.010 3.586 3.924 4.033 3.851 7 2.977 2.974 2.979 2.829 2.855 2.8l3 8 4.283 4.327 4.256 4.580 4.570 4.586 9 3.938 3.876 3.971 3.904 3.857 3.933 10 3.061 3.242 2.955 2.782 2.849 2.739 E Scales 1 4.333 4.544 4.198 4.626 4.659 4.605 2 3.799 4.097 3.623 3.956 4.099 3.860 3 3.100 3.ll6 3.092 2.964 2.944 2.975 169 The total number of group movements suggests that Group 1 acted more independently than Group 2 since Group 1 moved away from Group 2 50% more times and moved toward only 70% of the time. To summarize the Delphi process in two rounds of interaction, the following conclusions can be inferred: 1. An increase in consensus of .77 in Round Two was achieved on the following scales: Life Tasks Basic Sciences Direct Client Service Health-Illness-Health Human Development OT Theory OT in the Schools Scale 1 500501-th l The Emerging Scales reached .77 consensus on EScale 2, 0T Theory and EScale 9, OT in the Schools. Considering the scale means in relation to Group 1 (FCD) and Group 2 (RG), Group 2 was influenced more times to move toward Group 1 than was Group 2 to move toward Group 1. Considering the factor of independence of inter- active influence on scale means, Group 1 acted more independently than Group 2. The lowest consensus of all scales, from .386 — .540, was on Scale 7 (EScale 3), Indirect Client Services, and Scale 10, Family Studies. The lowest scale means, from 2.78 - 2.98, were also on these scales. This seems to indicate that there is less agreement among 170 all panelists and lower ranking of essentiality on Emerging Scales. This conclusion is supported at the opposite end of the ranking - essential or absolutely essential - in which there was higher consensus on all ESSENTIAL Competencies. Summary of Research Findings This chapter has included the research findings related to each research question and the Delphi process in general. Results of the hypotheses tested were given as were summaries of each question for Rounds One and Two. The next chapter contains the overall summary of the study, discussion and conclusions, followed by implications and recommendations. Footnote 128Warwick, Donald P., and Lininger, Charles. The Sample Survey: Theory and Practice. New York: McGraw-Hill Book Co., 1975. Chapter V SUMMARY, CONCLUSIONS, IMPLICATIONS AND RECOMMENDATIONS The purpose of this study was to determine the ESSENTIAL, SUPPLEMENTARY and EMERGING Competencies needed by OTs and to propose a lifelong educational model for maintaining professional competency, derived from the implications of the findings of this study. The following objectives were identified as a result of the intent of the study: 1. To define the competencies needed by occupational therapists. 2. To validate by obtaining consensus of members of the profession as to the ESSENTIAL, SUPPLEMENTARY and EMERGING Competencies needed by occupa- tional therapists. 3. To derive an educational model for lifelong professional development from the data analysis. The three-phase methodology was used to accomplish the objectives and to answer the research questions. Phase 1 consisted of identi- fying occupational therapy competencies from the Essentials of an Accredited Educational Program for the Occupational Therapist, 129 the Ohio University Task Analysis Study, and Fidler's "A Guide to Planning and Measuring Growth Experiences in the Clinical Affilia- 130 tion." To discover competencies needed by health professionals 171 172 based on social policy legislation, pertinent laws were reviewed and implications for occupational therapy practice and education were delineated. Since maintaining professional competency through the recerti- fication process is a necessary obligation of practicing therapists, literature regarding this process and other related areas were reviewed to obtain EMERGING Competencies. With the study's emphasis on competencies it was deemed advisable to review competency-based education as a background for the study. Phase 2 consisted of designing the OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY which would be used to obtain the data necessary for validating those competencies identified in Phase 1. After the INVENTORY was designed, it was pilot tested by five Fellows of AOTA who resided in Michigan. Revision of the INVENTORY followed to prepare it for dissemination in Phase 3. Phase 3 was initiated to accomplish Objective #2. For this part of the study the Delphi procedure for obtaining opinions of a panel of experts was used. Because of the extreme length of the INVENTORY (28 pages), only two rounds of collecting data from panelists were planned. This was one round short of the average number of rounds used in most Delphi studies. Having a nearly complete list of competencies included in the first round compensated in part for shortening the number of rounds. The stratified and systematic random sampling procedures drew from a population of nearly 25,000 OTs nationwide. Fellows of the AOTA were selected because of their recognized contributions to continuing education. Curricula directors of both occupational 173 therapists and competencies assistants educational programs were chosen because of their knowledge of the AOTA Essentials and the educational process. To balance the sample with practicing therapists in the field, recent graduates from 1975 and 1978 were selected because they would have gone through school under the present AOTA Essentials and would have had a chance to practice after graduation for from two to five years. Hoping to have a sample of at least 300 to use for data analysis, 842 persons were sent INVENTORIES: 251 Fellows and Curriculum Directors and 591 Recent Graduates. Responses from 301 OTs were returned usable in Round One. Round Two panelists returned 229 or 76% of those mailed out. The INVENTORY contained 124 content variables and 16 demographic variables. The Round Two INVENTORY consisted of two parts: part 1 was the same as the first INVENTORY except for clarifying wording and definitions; part 2 contained all of the competencies submitted by panelists in Round One. Panelists were asked to respond to both parts, but if time did not permit, it was critical for them to complete part one. Additional feedback in Round Two was in the form of histograms for each competency statement showing the frequency of responses in each of the five response columns, indicating how essential or important the panelists judged the statement to be. Means of each variable were also given. The time for completing both rounds was about 3-1/2 months from the date of the first mailing to the return of the last INVEN- TORIES. About two months passed from the first to the second mailing. Returns were mailed back slowly and follow-up cards had to be mailed about 3-4 weeks after the initial mailing. The responses were 174 coded by hand and computer to prepare the data for analysis. Data analysis focused on the research questions which were designed to give answers to resolve the problem under study and fulfill the intent of the research. Seven questions were asked and eight hypotheses generated. From the review of the literature the Delphi procedure was selected because of its applicability to a study of this kind. Substituting for committee meetings or brainstorming sessions, the mailed questionnaires helped to obtain consensus of opinions of panelists regarding the variables under study. Consensus came about as a result of the group process. Although 11 competency statements reached a consensus of .77 (out of a possible 1.00) or better in the first round, 47 of the 78 competencies declared essential by panelists reached consensus; none of the 41 supplementary competencies, 20 of the 72 emerging competencies (16 were essential, none supplementary); and four of the five competencies judged to be useful but not essential, reached consensus. The summary of consensus is shown in Table 11. The process of change in consensus between the two rounds is shown graphically in Figure 7. Three different illustrations of how most of the consensus changed depict the change in the means for each: if the first round mean and concentration of responses was in column 1, in which the mean would be low, the mean of the second round decreased; if the concentration was to the left at 4 or 5, the second round mean increased; if the concentration was in the middle, the mean stayed nearly the same. Figure 5 shows 175 .msmgmoumwz anew: ozp use «no mvcsom cw mpcmemumam aucmpmqsoo op mmmcoamwe 4o com_gmasou .n mczmwu mw.m n cam: + +.mm.m u cam: :1 .mwa we AHPFezc use mmmoosq m>wuamum mg» mucosaopm>ou a_wsm$\Fm=cm>wucw o“ Amsmpmxm a__Eee cwnpwz mcomcma we mocmucmawuemucw new cowuoegmucwv :umogaam Fmowmopoum mgu apqa< .om .m 96 Umeflch mm: mcomcwno $0 comumxpcmucou wzu cmz3 wEmm msa DCPCmewL :605 ms“ mwumgumzppw mco mw£H ”Vs? fl Cwmz + + ww.¢ H Emmi 31 .msmnsms apwsmw use mucmwpu .mpmcowmmmwogaco: use mpecomemwoga cmzpo saw: mawsmcopmeme newnpm; .mcmumzcu upwam .mm A.m caspouv muwm Hemp m;u_:ommz cowpmgucmocou mgu cos: came as» cw mmmmgucw cm mzosm mco mwgh ON.N H :mwz + T ”Nop H C602 A.mmmu:mgmzm uzospmz mxgoz Emumxm m on pcmupzmcoo mu so mam—a .mmmvw m.mco mo mucmpgmoum mmmpcegmzm Lo: xpmgogusm agomm>cmazm o: mm>wm some: Aemumxm m on acmapamcou m may awzmcowumpmg mcwupzmcoo e :Peumam .PN p N m ¢ m ..N«. e m .Ap usapoov mu_m agave may co apmuecvsoumgq we: mco ucaom cw mmmcoqmmg mo co_umeu=mocoo we» cos; 03h uczom co cums ms“ mo mcwgmzop m mzogm cowumgpmappw awe?» ugh .mumwpmcma 4o meow ucwao mo acmsm>os ms» m:_ueuwccw .uczoe acoumm on» Low Emgmopmw; mg» m? p;m_c we“ co .ucaoe “as“ Low cams on» use Auzmwg op ummpv _ 1 m mcsspou An mmmconmmc map mmpmowucm Emgmoumw; mco venom on» acmemumum aocmu -masou esp mcwch_od .mvczog :wwzpwa mpcmemgmum zucmumanu we mmcwumg cw wmcmco we» seem msmgmoum_; mmmch 176 .mEmLmoumw; mcwma age can mco mezzom c? mpcmEmpeum zocmpmaeou op mmmcoammg mo :omwgmgeou .Aumzcwucouv .m mgzmwd mm.m u Emmi + l MN.M H cam: “.msmumAm cw cow¢=w>cmpcw op mwwpqam meshv .msm_aoga xwwempo new xwwpcmuw .pcwEmmmmme mummc puzucou .55 .e =E=Fou cw we; corpmNPLmPoa mwgw 2mg: cowumgpcwucoo mcp ccmzop came cw wmmwgomu m mzosm wco ummp on» 177 graphically the convergence to consensus on all scales between Rounds One and Two. Since it is important to achieve as much consensus as possible in order to be able to say with some degree of confidence that a high percentage of the total group agreed on the essentiality of the competencies, two choices were possible after Round Two. One was to consider doing a third round, as the Young study did. However, both the numbers in the sample and the size of the instru- ment were substantially smaller than in this study. The other choice was to identify the variables reaching consensus at a selected figure and describe the results in terms of these considerations. It is the second choice which was the better alternative. A complete description of the competencies selected by the panelists as being essential at entry level, those supplementary to the more important competencies, and the emerging ones which fitted into the essential, supplementary or useful but not essential categories is summarized in Table 17, Scales identified by variable number and essentiality. Research Questions 1 - 3 dealt with the identification of these competencies. From the results of the analysis of consensus completed for Research Question 4, it is evident that greater consensus was obtained overall for competencies viewed as ESSENTIAL. SUPPLEMENTARY Competencies, ranked by panelists as minimally to probably essential, reflected a wider range of opinions. Since three of the five useful but not essential compe- tencies reached consensus, less polarization of opinions is evident. Differences between groups or subpopulations comprised the remainder of the data analysis. Research Question 5 tested the 178 Table 17. Scales identified by variable number and essentiality. Essential - Es; Supplementary - 5; Useful, but not Essential - U. SCALE 1 SCALE 5 SCALE 7 SCALE 1o ESCALE 3 V 1 Es V 35 Es (Cont.) V 10 S (Cont.) 2 Es 35 Es v 84 s 12 s v 71 S 3 Es 37 Es 85 s 42 S 72 S 4 Es 38 Es 86 S 43 S 73 S 5 s 39 Es 89 s 44 s 75 Es 5 Es 40 s 90 Es 49 s 75 Es 7 s 41 s 91 s 74 S 77 U 8 Es 46 Es 92 S 79 S 78 S 9 Es 48 Es 93 s 80 s 94 u EMERGING 81 S SCALE 2 SCALE 5 95 s scAEES‘" 82 s v11 Es v 50 Es 95 ES Scales 9 83 5 13 Es 51 Es 97 ES and 10 are 84 S 14 Es 52 Es 98 ES EScales 4 85 S 15 Es 53 Es 99 ES and 5 85 5 54 Es ‘00 5 g; E S SCALE 3 SCALE 7 SCALE 8 ESCALE 1 89 s V16 Es ———————- V 17 Es 9O Es 17 Es v 55 s V 88 ES 19 Es 91 s 18 Es 55 S 95 ES 28 Es 92 s 19 Es 57 s ‘01 ES 29 Es 93 s 20 Es 58 Es ‘02 ES 94 u 21 Es 59 u ‘03 ES ESCALE 2 95 s 22 Es 50 S ‘04 E5 95 Es 23 Es 51 u ‘05 55 V 50 ES 97 Es 24 Es 52 Es ‘05 ES 5] ES 98 Es 25 Es 53 Es ‘07 ES 52 ES 99 Es 25 Es 54 u 133 E: 53 ES 100 S g; E: 22 E5 110 Es 138231;;3 23 Es 29 Es 57 Es 1“ ES v 55 s 104 Es 45 s 58 s ‘12 ES 56 S 47 Es 59 s 1‘3 ES 57 s 87 5 7o Es ‘14 5 58 Es 71 s 59 u SCALE 4 72 s §£flL§_2 50 s 73 S V115 s 51 u V3? E: 75 Es 115 Es 52 Es 32 ES 75 Es 117 Es 53 Es 33 E 77 u 118 Es 54 u S 78 S 119 Es 65 Es 34 Es 80 s 120 Es 55 s 81 s 121 s 57 Es 82 S 122 Es 58 s 83 S 123 Es 59 s 124 S 70 ES 179 hypothesis that there would be no significant difference between panelist subgroups, the Fellows of AOTA and the Curriculum Directors in one group, and the Research Graduates in a second. The null hypothesis was rejected because in both rounds there was a difference between groups. Research Question 6 contained hypotheses about other subpopula- tions, namely panelists' education, years in practice, work setting and work function. Multivariate Tests of Significance, Univariate F-Tests and Roy-Bargman Stepdown F Test were all used in the computer SPSS program. All scales in the study, the eight Existing and five emerging, were tested for significance between groups in a research design described in the following figure: Roy-Bargman Stepdown F Tests Multivariate Test of Significance Univariate F Tests Panelists Group 1 Panelists Group 2 Under 5 years Years in P?33t1€§ 5 - 10 years Scales l - 13 11 or more years 8.5., B.A., OT . Certificate Education MOT Scales l - 13 Graduate Education Hospital, rehabilitation Work center Settin Other Scales 1 - 13 Work Direct Client Service Fin—Etion Scales 1 - 13 Indirect Client Service Figure 8. Statistical tests used to determine differences between groups on all scales. 180 The last research question identified the frequencies of res- ponses to two questions: Would OTs take a job in a nontraditional setting, and if so, for what reasons? Conclusions: Of the 293 who responded, 243 would change jobs, 50 would not change jobs. Reasons for change ranked by frequency of responses: 1. Interest in the nontraditional setting. 2. Desirable client p0pulation (a tie with the first reason). 3. Miscellaneous personal reasons. 4. Want to develop own job. 5. Because job is available. Summary of Findings 1. What are the ESSENTIAL Competencies needed for entry into the profession of occupational therapy, as perceived by a Delphi panel of experts in the field? The following competencies were judged to be essential at .77 or higher degree of consensus: SCALE 1: Specific Life Tasks and Activities Vl: Analyze the processes involved in selected tasks and activities in terms of skills and performance. V2: Relate specific life tasks and activities to client's abilities, limitations, goals, life satisfaction and lifestyle activities. V4: Analyze and integrate developmental tasks, daily activities, and skill development in the performance of activities. 181 V6: Identify and analyze tasks and activities in terms of the following components: physical, sensorimotor, cognitive, psycho- logical, social, cultural and economic. V8: Relate social role behavior and skills in self-care, work and play to the development of a person's competence and poten- tial. SCALE 2: Basic Human Sciences Vll: Know the human growth process: biological, reflex, perceptual, sensorimotor, cognitive, emotion, intellectual, social and cultural. V13: Relate social-cultural system of client to individual development and functioning. V15: Know the structure and function of the human body and body systems. SCALE 3: Direct Client Services V16: Instruct a client in carrying out a program of purpose- ful activities. V18: Evaluate client's abilities and deficits to present functional living skills profile and to obtain occupational history. V20: Facilitate and support client's active participation and investment in therapeutic activity program. V21: Evaluate the client's response to treatment. V22: Verify assessments, share findings with client and team members and make recommendations. V23: Explain theories and principles of occupational therapy clearly, understandably to others, verbally and written. V24: Record and report client data orally and written. 182 V25: Adapt environment/activities to meet client's goals and needs. V26: Communicate recommendations for follow-up, referral or termination. SCALE 4: Health-Illness-Health V30: Evaluate biological, social and psychological well-being. V31: Relate concept of ”wellness" to biological, social and psychological well-being and influences on health and quality of life. V32: Relate occupational performance to health, developmental tasks of life periods, performance skills, and life satisfaction. V33: Know the etiology, progress, management and prognosis of congenital and developmental defects and deficits, disease process and mechanisms. SCALE 5: Human Development Process V38: Acquisition of developmental tasks throughout life cycle. V39: Relate occupational performance activities and skill com- ponents to the acquisition of developmental tasks throughout life. V46: Analyze the learning of adaptive skills necessary for accomplishing developmental tasks essential to productive living. SCALE 6: Occupational Therapy Theory V52: Analyze the distortion of occupation in the presence of illness, injury, dysfunction and deficits on living throughout life. V53: Analyze the use of occupation as a force in identifying and assessing health problems, prescribed for goal achievement, in human development and in the presence of pathology. 183 SCALE 7: Indirect Client Services V62: Build trusting, helping relationships with other profes- sionals, nonprofessionals, clients and family members. V65: Engage in problem-solving by listening and clarifying to obtain the real problem. V70: Identify community resources and know information seeking process. V97: Team working. SCALE 8: Personal Performance Skills and Attitudes V88: Initiate and direct one's own professional growth on a continuing basis. V96: Maintaining professionalism. V101: Problem-solving skills. V102: Communication skills. V106: Perceive and accept responsibility. V109: Motivation and commitment. V110: Resourcefulness and creativity. Vlll: Self-awareness. V112: Relatedness to others. V113: Objectivity and judgment. SCALE 9: Occupational Therapy in the Schools V118: Engage in consensual decision-making. V119: Document performance objectives. V120: Apply OT theory to educational programs. SCALE 10: Family Studies None 184 EMERGING SCALE 1: Direct Client Services V17: Apply OT theory to clients of all ages with or without disabilities. V19: Develop functional living program in cooperation with client, family and other members of the health-care team. V29: Apply purpose of adaptive devices and equipment to clients' needs; know where to purchase and how to adjust or adapt. EMERGING SCALE 2: Occupational Therapy Theory V52: Analyze the distortion of occupation in the presence of illness, injury, dysfunction and deficits on living throughout life. V53: Analyze the use of occupation as a force in identifying and assessing health problems, prescribed for goal achievement, in human development and in the presence of pathology. EMERGING SCALE 3: Indirect Client Services V48: Analyze behavioral theories - how behavior is influenced and how people are motivated. V62: Build trusting, helping relationships. V65: Engage in problem-solving. V70: Identify community resources and know information seeking process. V88: Initiate and direct one's professional growth. V96: Maintaining a level of professionalism. V97: Team working with professionals. V98: Knowledge of personal liability, professional ethics, etc. V99: Articulating uniqueness of OT. 185 This is a total of 47 different variables which reflect consensus of .77 or higher. Table 11 gives a total number of essential, supple- mentary and emerging, useful but not essential competencies judged so by the panelists. 2. What are the SUPPLEMENTARY Competencies needed for entry into the profession of occupational therapy, as perceived by a Delphi panel of professionals in the field? The following competencies were judged to be minimally or prob- ably essential, the operational definition of SUPPLEMENTARY Compe- tencies, at .700 - .751 degree of consensus (none reached .77). SCALE 1: p§pecific Life Tasks and Activities None SCALE 2: Basic Human Sciences None SCALE 3: Direct Client Services V87: Identify such concepts as the dynamics of occupation and apply to all areas of OT specialization. SCALE 4: Health-Illness-Health None SCALE 5: Human Development Process None SCALE 6: Occupational Therapy Theory None SCALE 7: Indirect Client Services V85: Function as a researcher by promoting research. 186 V93: Assist clients to redefine their roles in order to parti- cipate in a desired change. SCALE 8: Personal Performance Skills and Attitudes None SCALE 9: Occupational Therapy in the Schools None SCALE 10: Family Studies V44: Identify influences of measures of life satisfaction on individual and/or family goal setting. V49: Apply the ecological approach to individual/family develop- ment, the adaptive process and quality of life. EMERGING SCALE 1: Direct Client Services None EMERGING SCALE 2: Occupational Therapy Theory None EMERGING SCALE 3: Indirect Client Services V85: Function as a researcher by promoting research. V87: Identify such concepts as the dynamics of occupation and apply to all areas of OT specialization. V93: Assist clients to redefine their roles in order to parti- cipate in a desired change. Only five SUPPLEMENTARY Competencies reached .70 - .75 degree of consensus out of a total possible number of 41. 3. What are the EMERGING Competencies which OTs need to practice in nontraditional settings, as perceived by a Delphi panel of profes- sionals in the field? 187 The EMERGING Competencies which reached consensus of .77 are the following: ESSENTIAL EMERGING SCALE 1: Direct Client Services V17: Apply OT theory to clients of all ages with or without disabilities. V19: Develop functional living program in cooperation with client, family and other members of the health-care team. V29: Apply purpose of adaptive devices and equipment to clients' needs; know where to purchase and how to adjust or adapt. EMERGING SCALE 2: Occupational Therapy Theory V52: Analyze the distortion of occupation in the presence of illness, injury, dysfunction and deficits on living throughout life. V53: Analyze the use of occupation as a force in identifying and assessing health problems, prescribed for goal achievement, in human development and in the presence of pathology. EMERGING SCALE 3: Indirect Client Services V48: Analyze behavioral theories - how behavior is influenced and how people are motivated. V62: Build trusting, helping relationships. V65: Engage in problem-solving. V70: Identify community resources and know information seeking process. V88: Initiate and direct one's professional growth. V96: Maintaining a level of professionalism. V97: Team working with professionals. 188 V98: Knowledge of personal libability, professional ethics, etc. V99: Articulating uniqueness of OT. EMERGING SCALE 4 (Scale 9): OT in the Schools V118: Engage in consensual decision-making. V119: Document performance objectives. V120: Apply 0T theory to educational programs. SUPPLEMENTARY: None USEFUL BUT NOT ESSENTIAL: EMERGING SCALE 3: Indirect Client Services V59: Writing proposals for funding and knowing where to obtain funding. I V61: Function as a consultant to a system. V64: Consult to a system. V94: Be an independent practitioner. This is a total of only 20 EMERGING Competencies; 19 additional ones reached consensus of .70 - .77, however. This represents a total of 39 out of 72, or 54% of emerging competencies. 4. What degree of consensus is there across members of the profession regarding the ESSENTIAL, SUPPLEMENTARY and EMERGING Competencies? The percentage of ESSENTIAL, SUPPLEMENTARY and EMERGING Compe- tencies reaching consensus out of a total possible number for each of these groups are the following: 189 ESSENTIAL Competencies: 60% (47 of 78) SUPPLEMENTARY Competencies: 0% EMERGING Competencies: 28% (20 of 72) 5. What degree of consensus is there among the Fellows and Curri- culum Directors (Group 1) and Recent Graduates (Group 2) regarding the ESSENTIAL, SUPPLEMENTARY and EMERGING Competencies? In both rounds a difference was found in how both groups viewed the entire INVENTORY. Group 1, Fellows and Curriculum Directors considered Specific Life Tasks and Activities, Basic Human Sciences, Direct Client Services, Health-Illness-Health, Human Development Process, and OT Theory more essential. Group 2, Recent Graduates, considered Indirect Client Services and EMERGING Competencies in Indirect Client Services and OT in the Schools more essential. Nearly all of these are EMERGING Compe- tencies. 6. Do significant differences exist between the variable scales and the following demographic variables of the panelists: profes- sional educational degree, number of years in practice, work setting and work function? 190 Educational Degree (ED) In Round Two, education subpopulation groups differed in percep- tion of the total INVENTORY; this was not true in Round One. There were no signfiicant differences found in Round One. In Round Two the differences found are listed in Table 18. Years in Practice as an OT As subpopulation groups, years of work experience made a difference on how the total competencies in the INVENTORY were judged, according to Round Two; in Round One this perception applied to Emerging Scales only. Differences between subpopulations are sum- marized in Table 18. Work Setting As subpopulation groups, work setting made a difference in how OTs viewed the entire INVENTORY on Emerging Scales in Round Two only. Differences between groups are summarized in Table 18. Work Function In Round One, the work function subpopulation groups viewed the EMERGING Competencies as a whole in the INVENTORY significantly different, butnot the Existing Scales. 191 Table 18. Rank order of essentiality of scales by demographic group. * = Round Two, ** = Round One, *** = l is most essential Human OT in Family EDUCATION Development* the Schools* Studies* ED 1 3 ]*** 3 (B.A.lB.S. OT or Certificate in OT) ED 2 2 2 2 (MOT) ED 3 l 3 1 (Graduate Study) *8 be ..e *3: 31 4.333 * -p 3 * * -H13 5 t * (1:75 c: +4 * 0:35 * * :5 U) 'Pv (U : cr-V UV if. 801 gm 2 3’ {3.5 i’ 8 «pm Cu O) In) D. O Q) 8 +3: 88 '— 46-2 0% :2 g 82 .c :0 Lor- 0) 01> "'02 «um I'- m> f— °PO 'l-> YEARS IN PRACTICE 2: 3: {,3 ‘3'; g a ,_ .t a; .— P5 253 ...I DU) mm ID 0 DU) 0 CW Hm Less than 5 years 3 3 2 2 2 2 2 1 2 5 - 10 years 2 2 3 3 3 3 3 2 1 11 years or more 1 1 l l l l l 3 3 Health-Illness OT Theory WORK SETTING Health** OT Theory* (Emerging)* Hospital, rehabilitation center 2 2 2 Other (nontraditional) l l 1 Human OT Direct Client WORK FUNCTION Life Tasks** Development* Theory* Service (E)** Direct Client Services 2 2 2 2 Indirect Client 1 1 1 1 Services 192 In Round Two, the work function subpopulation groups viewed the EXISTING but not the EMERGING Competencies as a whole in the INVENTORY significantly different. Differences between groups are summarized in Table 18. 7. Would OTs take a job in a nontraditional setting, and if so, for what reasons? Yes, 243 panelists would take a job in a nontraditional setting; 50 would not. The reasons given for making such a change ranked in the follow- ing order: 1. Interest in nontraditional setting or Desirable client population 2. Miscellaneous personal reasons 3. Want to develop own job 4. Because job is available. 8. Two additional questions were asked panelists. One asked whether they had participated in any continuing education workshops, courses or conferences in the past year. Of 284 responses, 258 said yes, and 26 said no. The other question was concerning present employ- ment: are you presently employed? Of 284 responses, 252 said yes, 32 said no. 193 Discussion and Conclusions Essential Competencies Consensus at .77 was reached on 47 competencies, falling mainly within Direct Client Services, Specific Life Tasks and Activities, Basic Human Sciences, Health-Illness-Health, and Personal Performance Skills. The remaining scales, Human Development Process, OT Theory and OTirlthe Schools, showed only scattered high consensus. Lack of consensus exists generally on Indirect Client Services and Emerging Scales. To summarize, the following conclusions can be drawn: 1. The panelists as a majority agreed with small dis- person of responses that nearly all competencies in all scales were essential except Family Studies, Indirect Client Services and the remaining EScales. 2. Of the 124 variables in the study, 78 or 63% were declared essential. 3. The percent of all ESSENTIAL Competencies of .77 consensus was 60% 4. High consensus existed in Existing Scales; low in Emerging Scales. Supplementary Competencies No SUPPLEMENTARY Competencies had .77 agreement. Within the consensus range of .70 or higher, SUPPLEMENTARY Competencies were within Scale 7, Indirect Client Services; Scale 3, Direct Client Services; and EScale 3, Indirect Client Services. Since SUPPLEMENTARY 194 Competencies were dispersed among all scales except Scales 2, 4, 6 and EScales l and 2, panelist group comparison of differences on separate competency items was not computed. To summarize, the following conclusions can be drawn: 1. SUPPLEMENTARY Competencies fell primarily within Emerging Scales. None reached .77 consensus or higher. At .70 consensus, five SUPPLEMENTARY Competencies reached consensus. Of the 124 variables in the study, 41 or 33% were SUPPLEMENTARY Competencies. Only five reached .70 consensus which was 15% of all the SUPPLEMENTARY Competencies in the study. Panelists converged to consensus on SUPPLEMENTARY Competencies at a much smaller rate than on the ESSENTIAL Competencies. In other words, panelists' opinions of SUPPLEMENTARY Competencies were dispersed much more widely than were ESSENTIAL Competencies. Panelists reached .70 consensus on competencies judged SUPPLEMENTARY in Emerging Scales only. EmergingCompetencies Within the consensus range of .77 or higher, 16 EMERGING Compe- tencies were considered essential, none supplementary and four useful but not essential. In the study, 72 of the 124 variables were EMERGING, which was 58% of the variables. Of the 72 variables, 195 37 or 51% were judged to be Essential; 31 or 42% Supplementary, and five or 7% Useful but not Essential. Of all competencies in the Emerging Scale of Indirect Client Services (47), 34% or 16 were considered Essential. Of the 16, 50% reached consensus of .77 or higher. The following conclusions can be drawn: 1. EMERGING Competencies in agreement by over 50% of the panelists are primarily in Indirect Client Services. 2. Although 58% of the variables in the study were Emerging, only 20 or 28% reached consensus of .77 or higher, indicating lack of agreement by panelists on EMERGING Competencies. 3. The content area of the EMERGING Competencies declared Essential and reaching .77 consensus were the following: a. Applying OT to clients with and without disabilities. b. Developing functional living programs with team members. c. Applying purpose of adaptive devices to client's needs. d. OT Theory: distortion of occupation lifelong. e. OT Theory: use of occupation as a force in iden- tifying and assessing health problems. f. Building trusting relationships. 9. Engaging in problem solving with team workers. h. Identifying community resources. 196 i. Team work. j. Apply OT theory to educational programs. k. Analyze behavioral theories. 1. Maintain professionalism. m. Initiate and direct one's professional growth. n. Articulate uniqueness of OT. Degree of Consensus In decreasing order, panelists agree at .77 about ESSENTIAL Com- petencies (60%), EMERGING Competencies (28%), and SUPPLEMENTARY Compe- tencies (0%). Consensus of four of the five Useful but not Essential Competencies was also obtained. The Delphi process was effective in getting increased consensus in the second round (250% on number of scales increased over the first round). The interactive element was present in both Groups, somewhat more in Group 2 than 1. Group 2 in- creased in consensus on Scale 10 from .412 to .809 in Round Two, while Group 1 dropped to .412. The Recent Graduates as a group (Group 2) agreed much more strongly than did Fellows and Curriculum Directors that these competencies are supplementary (X = 2.78). Degree of Consensus Between Groups Independently, Groups 1 and 2 reached .77 consensus in Rounds One and Two according to these frequencies: Round One Round Two Group I Group 2 Group I Grou 2 Scale 3 l l I 3 3 2 4 4 3 8 5 4 6 5 7 6 EScale 2 9 3 10 EScale 2 197 As a group, Recent Graduates were in stronger agreement than Fellows and Curriculum Directors. Although not as centrally polarized in their opinions, Group 1 was different from Group 2 in judgments of essentiality of Scales l - 6, And EScales l and 2. The Recent Graduates viewed Scales 7, 9, and EScale 3 as more essential. These were in the content areas of Indirect Client Services and OT in the Schools. Differences Between Subpopulations Educational Degree In Round Two differences in educational level were significant on Scale 5, Human Development Process: more education varied directly with the essentiality of this scale. Conversely, less education (B.A., B.S./OT, or Certificate) perceived OT in Schools (Scale 9) to be more essential than those with graduate education. Scale 10, Family Studies, varied in essentiality directly with more education. Years in Practice In Round One, increasing years of experience varied directly with the essentiality of Scale 1 and EScale 1 (Specific Life Tasks and Activities, and Direct Client Services). In Round Two, on Scales 2, 5, 6 and EScales l and 2, Group 3, over 11 years of work, viewed them as more essential, followed by Group 1 (less than 5 years) and Group 2 (5 - 10 years). On Scale 9, Group 1 was first in essentiality, followed by Groups 2 and 3. On EScale 3, Group 2 was followed by Groups 1 and 3. 198 Work Setting In Round One, Scale 4 was viewed by the nontraditional setting as more essential than the traditional setting. In Round Two, the nontraditional setting viewed Scale 6 and EScale 2 as more essential. Work Function In Round One only Scale 1 was significant. This scale was viewed as more essential by OTs in Indirect Client Services than OTs in Direct Client Services. In Round Two, Scales 5 and 6 were seen as more essential by Indirect Client Service OTs. In the Emerging Scales in Round One, EScale l was judged more essential by Indirect Client Services. In Round Two, EScale 2 was viewed as more essential by Indirect Client Services. Differences Between Subpopulations as Total Groups The subpopulations viewed the INVENTORY as a whole differently according to the following chart: Suppopulation Round One Round Two Educational Degree YES Years in Practice EMERGING SCALES YES Work Setting EMERGING SCALES Work Function EMERGING SCALES YES Change did occur between rounds as individuals interacted through the INVENTORY. Change to Nontraditional Settings Panelists would change to nontraditional settings: 243 yes, 50 no. The reasons given in rank order were interest in setting 199 and desirable client population, miscellaneous personal reasons, wanting to develop own job and last, because job is available. This question was important because if therapists would not change to a nontraditional setting, there would be little reason to consider EMERGING Competencies which were needed for nontraditional areas of practice such as OT in the Schools. Of the reasons given for making such a change, "wanting to develop own job" requires special competencies which the other reasons do not. Ranking next to last, this reason is important when considering the competencies which will be needed for transition into emerging practice areas where jobs are not already available. OTs will need the skill necessary to develop jobs where none presently exist. Present Employment Panelists were asked if they were presently employed. Of the 284 responding, 252 were employed, 32 were not. This gives a high ratio of employed to not employed in the sample. Participption in ContinuiugEducation Of 284 responses, 258 panelists had participated in workshops, courses, conferences in the past year. This large proportion of continuing education activity has implications for the educational model which is presented in this study. Discussion The purpose of this study was to determine the essential, supplementary, and emerging competencies needed by OTs and to propose a lifelong educational model for maintaining professional competency, 200 derived from the implications of the findings of this study. Three objectives were derived from the intent of the study. The first objective, to define the competencies needed by OTs, was accomplished through the literature review and Round One of the INVENTORY. The second objective, to validate or get consensus of members of the profession as to the essential, supplementary and emerging compe- tencies needed by OTs, was accomplished in the Delphi procedure which used two rounds of seeking opinions of panelists on variables in the INVENTORY. The determination of the significance of the data collected was accomplished in the statistical analysis proce- dures. Objective 3, deriving an educational model for lifelong professional development, follows the implication section. The problem for study was to identify the competencies needed to practice in the 1980s. These competencies were identified in the literature review which included analysis of social policy legislation for implications applicable to education of OTs. The determination of the importance of these emerging competencies in relation to the AOTA Essentials consumed the data collection and analysis. Had rank ordering competencies been the final objec- tive, a survey of panelists would have sufficed. Since.the goal was to obtain consensus regarding these competencies, a Delphi procedure was selected. Two rounds of data were analyzed and change of opinions of panelists in a movement toward consensus was calcu- lated. The findings included the ratings of essentiality given by panelists on 124 competency variables. Consensus convergences of groups of panelists and the entire sample population were 201 determined. The degrees of consensus were considered in relation to the essentiality of competencies and competency scales. The dimension of convergence to consensus which is the purpose of the Delphi procedure, is important as an indicator of group agree- ment. The results of this study with respect to consensus by spglg_ shows that 8 of the 13 scales obtained consensus of .813 or higher - an increase of 6 after Round One. Comparing these to means, only one scale, Family Studies, had a mean lower than 3.6, indicating that eight of the nine scales were considered essential at entry level. The scales which did not reach consensus at .77 were: Indirect Client Services and EScale 3 (also Indirect Client Services), Escale 1, Direct Client Services, and Scale 8, Personal Performance Skills and Attitudes and Family Studies. Of these five scales, three had means lower than 3.5, meaning that they are considered supplementary at entry level: they are Indirect Client Services, both existing and emerging, and Family Studies. The other two, Personal Performance and Direct Client Services, had means that placed them in the essential range. Analysis by scales supports individual variable results which indicated lower consensus in the supplementary competency area. In essence the findings regarding consensus and essentiality of variables indicate that panelists as a group agree on the competencies which are in the AOTA Essentials as still being essen- tial; the EMERGING Competencies, except for 0T Theory, lack agreement; all EMERGING Competencies were considered essential at entry level except Family Studies and Indirect Client Services. If the total panelist group is divided into the separate groups - Group 1, 202 Fellows and Curriculum Directors, and Group 2, Recent Graduates - to identify how essential were the scales in which the two groups were significantly different in their perceptions of the variables, the findings were that only Indirect Client Services were viewed as supplementary at entry level by both groups. The other scales were considered essential by both groups. Subpopulations were different with respect to essentiality: l. OTs with graduate degrees (ED 3) considered OT in the Schools to be supplementary, while both ED 1 and ED 2 said it was essential at entry level. ED 1 and 2 includes all of the Recent Graduates (Group 1). 2. All other subpopulations, although significantly different in how they viewed the scales, stayed within the essential at entry level range. Implications What are the implications of the research findings? It is necessary to review the need for this study and the report of the Ad Hoc Committee on Educational Standards Review, submitted to the Representative Assembly of AOTA in April, 1980. The movement away from the medical model to one of prevention and the shift to the community and the client's home has begun. OTs are now working in the schools of the nation in increasing numbers. The profession has supported a study which identified the competencies necessary for practice in schools with populations from birth to 21 or 25 years. Workshops to teach present practicing OTs the 203 skills and knowledge necessary for this non-medical setting have begun. In the fall of 1980 the workshops will be conducted in all states in the nation. The findings of this study indicate that Recent Graduates as a group consider the competencies needed for working in schools to be essential at entry level. OTs with more years of work experience consider these competencies NOT to be essential at entry level. If those who are already in the non- traditional practice area of schools realize the need for being prepared before graduation to work in schools, the profession must listen to what these practitioners are saying and observe what they are doing. Educational decisions can then be based on the reality of OTs' practice. The findings of the total panelist group also supported the competencies in the OT in the Schools scale as being essential at .842 consensus. Having this additional support for including the competencies needed for working in the schools in the entry level curriculum, the implication is that these should be added when the new AOTA Essentials are written. Another Emerging Scale, Family Studies, was thought by both panelist groups to be supplementary at entry level - not essential. Total group consensus was low. However, Group 2, Recent Graduates, had strong agreement while Group 1 had very low agreement. Again, the pratitioners who have graduated under the 1973 AOTA Essentials - Group 2 - as a group realize the importance of an emerging area of competency. The findings that emerging competencies in Indirect Client services are not essential at entry level - that they are 204 supplementary - and that they had low consensus by the total panelist group suggests implications for the profession. Graduates leave school prepared to be clinicians. The direct service role is familiar and desirable, not the indirect. Additionally, curriculum directors, in agreement with the AOTA Essentials, construct courses around the role of clinician - not the administrator, consultant, private practitioner or health planner. The report of the Ad Hoc Committee on Educational Standards Review endorsed the clinical practice role function for the OTR but rejected the role functions of con- sulting, administration and supervision, community health care planning and research. In this study the panelists also viewed the direct service role as essential, with strong agreement as a group. The competency related to community health care which was considered essential was V67 - provide OT services which promote health practices for prevention of illness and disability. The implications of the direct client service role versus the indirect - of the clinical practice role versus the nonclinical, are important and far reaching. Although the nonclinical role has been rejected as being essential at entry level, the role of the OT in the Schools was considered essential by the panelists in this study. This role is not a clinical one. According to the report of the Advanced Training for Occupational Therapists in the School Systems first year report,131 the consultation relation- ship of school staff, families, and occupational therapists is emerging as a paramount role in implementing occupational therapy school-based programs. This trend in indirect Client services, 205 the nonclinical role, cannot be denied. The profession must consider the alternatives which are possible at this time. One direction that is possible is for OTs to continue to follow the nonclinical role in settings other than schools. This direction is the one indicated by the changing health care scene, by the social policy legislation reviewed for this study, and the one chosen, although without strong agreement, by the panelists. The panelists favored indirect client services as being supplementary - not essential at entry level. It would seem that this is a step toward being essential, at the minimally or probably essential level. If these competencies are to be learned by OTs in order to practice in the nonclinical, nontraditional settings, where are they to be acquired? If at entry level, which the panelists suggested, there will need to be changes in the present AOTA Essentials. Since the panelists supported strongly all other non-emerging competency scales as being essential, can more competencies be added to the present OT curriculum? If not, specialization channels could be added to the entry level programs. Instead, as has been urged by leaders in the profession, the entry levelprogram could remain preparatory for the generalist, but require more pre-entry to the curriculum competencies so that there would be time for adding new competencies to the professional courses. Since that could be difficult at the baccalaureate level, movement to graduate entry is also an option. If the profession were to move to graduate entry to the pro- fession, more of the indirect client services such as research, 206 consultation, community health planning, and other independent practitioner skills could be learned. To ensure that these compe- tencies are learned, the competency-based model of education might want to be evaluated as one way for the profession to follow. The basic professional education which encompasses the uniqueness of occupational therapy and the application to practice could be learned together with the indirect service content and practice competencies. Such a drastic change in professional education would innately be resisted initially by curricula directors. The alternatives are for the profession to remain clinically, direct client service oriented, and prepare Clinicians as is presently being done. Wilson has written extensively about curriculum development. She says that faculty must identify the role the practitioner will fill and then the competencies necessary to fill that futuristic role. "Until we know what a practitioner will be doing, we cannot educate realistically or accountably."132 Education is viewed by Wilson as a preparation for the future which is often perceived as very little different from the past or present. Education must have the courage to change for the future, otherwise current emphases will be irrelevant and unacceptable. Wilson goes on to say that some health practitioner positions are in danger of extinction unless these professions can perceive a marked change in role for their practitioners and “carefully define the new role as a basis for changing education." The impli- cations of not moving in the direction of health care change and opportunities for expansion of the profession are serious and require careful consideration of the consequences of such action. The 207 profession has identified its uniqueness. Now it must decide whether it will continue to grow and respond to change, making the educational adjustments necessary, or remain static and traditional. It is important to note that the EMERGING competencies con- sidered ESSENTIAL by respondents focus on inter-relating with pro- fessionals, family members, community agencies; building relation- ships; health maintenance, which is broader than the technical aspects of professional services. This reflects a response to social and political changes: in community extension, practice of school systems, to disease prevention, all which were areas of the social policy legislation reviewed for this study. These com- petencies suggest an ecological approach to practice which is com- mensurate with an independent profession growing and expanding to best serve consumers of its service. Model of Lifelong Professional Development The areas of skills and knowledge which the professional OT learns at every level are the unique content of occupational therapy the core theory, principles, concepts. Cognate areas of interest embellish and enrich the core emphasis. Processes in occupational therapy practice (at present these are tasks that provide direct service to clients) and program support tasks include managing client service, supervising others, maintaining supplies and equip- ment, communication with team members and pertinent other persons. 208 This basic professional education prepares the OT for entry into the profession at the baccalaureate level. If this were a Masters in Occupational Therapy (MOT), graduate emphasis on research, critical thinking and scholarly writing would be acquired. In both professional programs field work practicums give the OT an opportunity to apply theory and principles to practice, under the supervision of a more knowledgeable person in a particular speciality area of practice (physical disabilities, psychiatry, pediatrics). A model of lifelong professional development begins with the education which prepares a person for entry into the field of practice. In Figure 9, current professional education is conceptualized in these components: unique occupational therapy core content, program support and field work; research, critical thinking and scholarly writing; masters and/or doctorate in occupational therapy with concentration in administration, education, pediatrics, psychosocial dysfunction, sensory inte- gration, motor dysfunction, genetic or physical disabilities. The routes of professional degree entry 209 I BASIC PROFESSIONAL EDUCATION J fi ‘ l - ' lCore I Program [field Work I A Support ‘ Generalist Clinician . Critical Thinker Scholarly Writer Researcher Nonformal Education — 1 Generalist Clinician B.S./8.A. OT Cert. Continued Graduate Study Graduate Study Critica Thinking ‘ Scholarly Writing Research SPECIALITY SKILL Administration, Pediatrics, Gerontology, Community Practice Education, Health, Family Ecology Child Development, Counseling Change of Recertification Practice Area Workshops Conferences NONFORMAL Inservice Self-study Maintaining Self-actualizing l Professional _ Competence Career Mobility Figure 9 . Content of educational experiences and goals of lifelong education. 210 are indicated as Bachelor of Arts or Science in Occupational Therapy (B.A.lB.S. OT, Certified OT) or Master of Occupational Therapy. The B.A./B.S. OT or Certified OT has several options for graduate education in occupational therapy at the master's or doctoral level. Graduate programs are available in related areas of study in education, health, family ecology, Child development, counseling, to name but a few. It must be stressed that graduate degree study focuses on research, critical thinking, scholarly writing with occasionally interpersonal practice applied experiences. Undergraduate or graduate degree programs are considered formal education since they lead to a degree, give credits to the learner, are planned and scheduled. Non-formal education is not a program leading to a degree (although occasionally university credits can be earned for a 3-5 day workshopk it is usually a one-time, short term learning experience. Workshops, conference, refresher courses, inservice programs or self-study modules are some examples of non- formal education. These are also planned and scheduled, as is formal education, in contrast to informal learning which is incidental, of varying lengths of time and occurring in a variety of settings. Examples are crafts, sports, or hobbies. Are OTs engaged in formal and nonformal learning after their basic professional education? This study has indicated that OTs who are practicing do continue to educate themselves through work- shops, conferences, courses and inservices. Of the panelists in the study 91% had participated in continuing education in the past year. In formal education, 32% had graduate degrees, not including the MOT. OTs now practicing must acquire skills to remain certified 211 and up-to-date in practice competency. The law mandates quality care, and individual practitioners set high standards for professional preparation and work. Based on the need to acquire entry level competency, maintain professional competency in practice skills, and often re-enter the profession after years of inactivity, lifelong education is an accepted way of life. The results of the data analysis have also indicated a need for the acquisition of EMERGING Competencies in areas such as OT in the Schools, Family Studies, and Indirect Client Services; some at entry level, some not. The Re-Entry Project's Needs Study133 of job descriptions of supervisors, administrators and staff OTs found that the most frequently mentioned functions of OTs are supervising and managing - skills that were not considered ESSENTIAL by the panelists. A 1979 AOTA survey of OT members to find out choices for continuing education listed the four high areas to be sensory integration, administration, consultation and research methods. These areas of competency can be obtained through graduate study or nonformal learning experiences. Other areas of personal or professional knowledge or skill can be acquired in nonformal education. WorkshopSsem usewpo pueswusH N Fessomsoz sowpusuosusH xspsm sowuuzuosusH Azsusev _ Azsusev p Fuzhou.— .mswsseep Cos meowosu ”mewuseaessou xueusesepsszm .op essmws swsmseuees pesowmmewoss mpemososs seupwsz suseemem maepmAm mswaewuomez e>mpememm4 use zuwpos Pewoom sesowpwuoess pseusmseusm spFee: was: geese sepees msmsseps sowusm>ess sowuoeoss supem: supemz apwszesou epos pseme easesu Eeymxm e segue: mswu—amsou somuesumwswsu< sowmw>ses=m mmwosepmasou 214 presently available in a few OT schools. This suggests that the process of inclusion of school practice competencies has started. Family Studies as a cognate area could be offered at the graduate level. However, OTs in practice in settings such as schools realize the need to understand and work closely with families. As a minimum, a course could be offered at the pre-professional level or later if it were designed to include the necessary components of family theory. All that has been said suggests a model of professional develop- ment that is continuous throughout one's professional life. It is also based on the reality that most of professional lifelong education is acquired as an adult learner. This requires that the needs of the adult learner be addressed in considering any human resource development model. They include relevant content that is useful at the given time; facilitation of learning, not auto- cratic presentation of material; offered at a pace and quantity that is comfortable; and presented with the understanding that learning is just one of the many tasks of persons throughout the life cycle. Learning will be formal and nonformal, intermittent, beginning at any time in a total life span, and located in a variety of settings. Figure 11 illustrates lifelong professional education. Adult develop- mental stages begin with Young Adulthood and continue through Adult- hood to retirement. Learning experiences, both formal and nonformal, take place over time following the basic professional education and are intermingled with other life activities. 215 [Basic Professional Education B.A./B.S. OT Certified 1 [_ M.A./M.S. ] Nonformal Learning Conferences Workshops Specialty Practice Education Inservice Self-study Re-Entry Competency Update Continuous Nonformal Learning YOUNG ADULT L I F E ADULT RETIREMENT S T A G E S Figure 11. A dynamic model of lifelong professional development. 216 Where will the educational experiences take place? During the formal professional education the settings will be either at the university or through the university extension. Graduate degrees could be obtained entirely off campus. Nonformal learning may occur either in the home through self-learning modules, in the work place or at conferences or workshops. The annual professional conference frequently is focused on continuing education. Responsibility for professional development rests ultimately with the learner. A competency in this study which had strong agreement and was rated highly essential was "to initiate and direct one's own professional growth on a continuing basis." Others have responsibility in the ongoing education of the professional - the employee - the graduate student. The profession has a responsibility to its members to offer specialization courses or workshops which are required as changes in professional direction occur. Basic professional education is also the responsibility of the profession through the accredita- tion process which maintains the essential standards for this educa- tion. Since the professional organization is the recertifying body in most instances, recertification as an educational process is also the responsibility of the professional association. Re- entering education, although an individually engaged learning exper- ience in part, should also be coordinated by the professional asso- ciation. The employer of OTs has a responsibility to offer educational experiences through on-the-job training to help orient the OT to the work setting, adjust to job functions or increase competency 217 in nonprofessional areas. This is particularly essential if the system in which the employee is entering is an unfamiliar one, such as OTs working in school systems. This should be ongoing yet intermittent, on an individual need basis. The need should be recognized for release time by the employer to allow the employee to attend professional workshops and conferences when the content is relevant to the work function and personal growth. The formal educational institutions also share the respon- sibilities for the educational process: initially for basic profes- sional education, for graduate education, and for continuing education. Because the professional is usually an adult learner, the college or university has an obligation to meet the needs of that person by offering the learning experience in a flexible, accommodating manner which allows the learner to integrate classes and studying time into family and work schedules. The competency-based educational model which permits the educational institiution and the learner to determine course objectives together, and plan and arrange the learning experiences so they will be useful, relevant and convenient, and permit individual pacing, has merit for professional education. The university must also be a link between the practicing professional and the academician through research activity. Pro- fessions must build a strong research base to support theory and undergird practice. In addition to being the interface between practice and education, faculty of the university curricula need to maintain contact with professional practice so that a gap does not develop between practice roles and what is being taught at 218 entry level. If university programs were constantly aware of practi- tioners needs, forming the basis for curricula change, the profes- sional educational programs would not need 8 - 10 year updating of program Essentials. It would become future oriented. Channels of communication must be kept open between those who desire learning experience on a continuing basis and those who are the providers. In this way practitioners can suggest content of workshops and conferences that has relevance to them. Questions such as "how do I know which kind of education I need - formal or nonformal" must be addressed through a counseling process if necessary. Information useful in the decision-making process can be furnished by the univesrity to potential learners requiring guidance and understanding. What responsibility rests with the professional practitioner in the lifelong education model? To be cognizant of the fact that the educational process is lifelong if professional competence is to be maintained; to plan for learning experiences when recog- nized as necessary or in one's best interest; to seek assistance in the decision-making process as needed and to maintain high quality practice standards. Most importantly the professional must believe that change can be personally effected. If nothing is done to plan for the future, there will be a probable future; if a little something is done, there will be a possible future; only when one deals with change and plans for the future in strong measure can there be a preferable future.134 When offering nonformal education, will the content of workshops be the same for both practicing professionals and non-practicing 219 re-entering persons? Surveys of continuing education needs of these two OTs have identified entirely different content requirements. Therapists not working for several years require a review of current practices, while those active in the field need work related skills and knowledge. Additionally, the re-entering therapist or other professional lacks self-confidence and courage to enter the work- place, and seeks encouragement and emotional support from friends and other professional associates. What are the motivational forces behind continuing education? To maintain professional certification which requires continuing competency, the nonformal learning experiences will occur "as needed." When Change of practice area is desired, graduate courses leading to a degree, or combination workshop/practice experiences may be preferred, along with self-study. For new specialization preparation, similar courses with related practice work may be desired. If a break in working of a few to several years interrupts practice, the re-entry process will require self-learning mixed with workshops and field work. Job mobility, social policy requirements, new professional standards may also prompt ongoing learning. A model of lifelong professional education has to be fluid in order to adjust to the schedules and needs of the adult learner. Change of careers at midlife is not unusual, and often involves formal education at this life stage or later. There are no limits to age for any learning incident. Only motivation and desire to acquire skills and knowledge are basic to when and how a person will move in and out of educational experiences. 220 The process of lifelong professional education is characterized by its fluidness, multiple entry times within the life stages of adults, alternating formal and nonformal, in the university, through university extension, week-end college, on-the-job training, con- ference, workshop or home setting. The educational experiences will be integrated with family living schedules and family goals. Responsibility for learning rests ultimately with the individual, with professional commitment and high competency standards directing and motivating the knowledge quest. Assistance in the learning process can be expected from both the professional organization and the employer, depending on the informational content and skill acquisition desired. The university as the center of formal education can be expected to consider the needs of the adult learner by furnish- ing innovative programs of study; it can also function as the link between practice and research. Practice of professionals is molded to fit the constraints of social policy and altered in response to consumer demands and needs, and changes in health care systems. Practitioners who are active in the field soon become aware of changes through mandate or edict, and communicate their problems to the professional organi- zation. Leaders in the field, being innovators frequently, recognize the changing pressures effecting practice and direct the professional organization as it responds to practitioner needs. To assist the practitioners in continuing education pursuits the professional organization through its member representatives studies problems and issues, and ultimately directs the professional entry curricula 221 to alter its basic essentials so it can become congruent with prac- tice role competencies. The period of time in which the change of basic entry skills and knowledge is in transition is one of great concentration on nonformal education so that the practitioner can maintain competency in the shifting health care systems. It is within this period that the profession of occupational therapy is moving in 1980. As new directions for entry-level education are considered, a caution would be that all possible alternatives be weighed carefully, and the final choice made without being hampered by the traditional. Too many 0T leaders have spoken for too many years without being heard. The profession must take action that will make occupational therapy a leader in health care and a provider of the highest quality service possible. Recommendations To the Profession of Occupational Therapy 1. The profession needs to consider seriously the fact that new practitioners in the field recognize the need to learn at entry- 1evel competencies that prepare them to practice in the emerging areas of practice, such as OT in the Schools. Recent graduates as a group are united in their opinions about this, as opposed to the Fellows and Curriculum Directors who do not as a group recog- nize the same urgency. 2. The issue of clinicalpractice role function as opposed to functioning as a consultant or other indirect client service roles needs to be looked at in terms of all of its implications 222 for the profession's growth and for education. This study agreed with the Ad Hoc Committee on Educational Standards Review that the indirect service roles are not essential at entry level, only minimally or probably essential. However, practice in the schools was deemed essential, and that area is not a clinical one consisting of only direct service. The profession should support the indirect client service role, both in the schools (OT practice in the schools) and elsewhere. 3. The only research competency which gained consensus as being essential was "promoting research". Numerous references in the literature review identified doing research as necessary. The AOTA member survey identified research as a high continuing education area. If moving entry into the profession to the graduate level would allow this to happen, then the Representative Assembly should take that action, giving due thought to other considerations. 4. Recent graduates as a group indicated strong agreement on Family Studies being minimally or probably essential. Since they are practicing in emerging areas such as the schools and recog- nize the importance of this area, consideration needs to be given to suggesting Family Studies as an area of related studies in graduate education of OTs. 5. Since the AOTA Essentials are structured in competency form in the area of content, and the recertification process is a competency assurance one which uses competencies as outcomes of learning as a basis for planning the self-assessment case studies which have been developed by AOTA, it would seem for these reasons to gradually change to a competency-based model for basic 223 professional education. The model has merits which have been discussed in the literature review, relevant to occupational therapy education. 6. OTs need to become comfortable with technology and their interface with other professionals such as the rehabilitation engineer as they develop a mutually beneficial team relationship. To the Educators of Occupational Therapists 1. Based on the trends suggested by this study toward moving from the clinical role to the indirect service role, and the recom- mendations of numerous leaders in the field of occupational therapy, educational preparation of OTs for entry into the profession should consider moving to the graduate level. 2. The lifelong education model presented in this study should be adopted for the continuous education of OTs by the profession, the universities, employers of OTs and therapists themselves. 3. To accommodate the OTs who want graduate education but cannot arrange full-time on-campus classes, universities need to consider innovative nontraditional approaches to obtaining graduate degrees. To Future Research in the Area of OTs' Competencies l. The Delphi procedure was effective in obtaining agreement among panelists in this study, keeping in mind the lengthy INVENTORY and the small number of rounds. If used in a similar study, the following suggestions would improve the study: a. Use competency statements which are as free from "jargon" as possible. b. Include in Round One definitions to clarify all but the simplest terms. 224 c. In Part 2 of Round Two which contained additional competencies from Round One, reduce the number to the smallest possible by condensing and eliminating. In this study Part 2 contained too many enabling objectives which represented personal interest areas; others were repetitious of Part 1. d. Obtain agreement from panelists prior to mailing Round One in order to reduce part of the cost of the two-thirds which were not returned completed. e. If possible, use a response category which would not be controversial; in this study the issue of "being more essential than essential (absolutely essential)" was confusing to many. Since the final goal was to rank the competencies by importance at entry-level, a five-point scale of importance could have been used. This was explained as an alternative in Round Two. f. Sending a copy of the reference list from the study as an incentive to obtaining cooperation of panelists in completing the study did not seem to be effective judging by the large number of returned reference lists. 2. There are data which remain from the comnents and letters received with the returned INVENTORIES. Part 2 was not coded nor summarized because it was considered by many to be repetitious. Comments about competencies have been retrieved but are not summarized 225 in the study. Further information is potentially obtainable from the data collected in this study. 3. The study proved to be a much larger one than was initially conceived. A pilot study only to test the "model" would have been advisable financially and in terms of energy expenditure. 4. The pilot group of Fellows from Michigan were extremely helpful in many ways: through personal conversations, reviewing of the first INVENTORY, and in numerous written comments. A group of this kind with the expertise of the Fellows is necessary. 5. Research into other nontraditional areas of practice similar to OT in the Schools would be wise, such as the role of OTs in geria- trics, in community health, in independent living, and in industrial settings. The format used for the OT in the Schools study would yield information valuable in identifying the necessary competencies. 6. Study more thoroughly OT educational programs using CBE or variations thereof, as a possible alternative to traditional education. 7. The competencies identified in this study are the basis of an OT curriculum; they can be used for setting priorities in OT education. 8. Since consensus was high only on the EXISTING ESSENTIAL Competencies, research should be done to determine which group of OTs contains those who resist change and why. Is it the cautious, more experienced professional, the curriculum director, or the recent graduate? Chapter V has included a summary of the study with results and conclusions. Discussion of the results and conclusions was 226 followed by implications of the results, and recommendations. The final objective, to derive an educational model for lifelong profes- sional development from the data accumulated in the study, was accom- plished with the presentation of a lifelong educational model. Recommendations were offered to the profession of occupational therapy, to the educators of OTs, and for further research. Based on the selection of the sample for the study, and the data analysis methodo- logy, the results have the potential generalizability to the profes- sion. The findings can be used in studies related to the area of competencies necessary for entry into the profession of occupational therapy. The educational model is applicable to other health profes- sions in the area of lifelong professional development. Footnotes 129Ohio State University, School of Allied Medical Professions: Develppment of Occupational Therapy Job Descriptions and Curricula through Task Analysis, Reports No. 1-6, Columbus, Ohio, The State University, 1971. 130Fidler, Gail S., "A Guide to Planning and Measuring Growth Experiences in the Clinical Affiliation." American Journal of Occu- pational Therapy, 28, 6 (1964). 131Advanced Training for Occupational Therapists in the School Systems, First Year Report, American Occupational Therapy Association, May 1979. 132Wilson, Margaret. Eguivalency Evaluation in Development of Health Practitioners. (New Jersey: Charles B. Slack, Inc., l976). 133Re-Entry Project Needs Study, Western Michigan University, 1979, unpublished report. 134 Ibid. APPENDICES APPENDIX A Sources of Competencies APPENDIX A Sources of Competencies Occupational Therapy Theory and Practice (From social policy legislation.) 1. 2. 3. 10. 11. How to access unfamiliar systems. Do a comprehensive needs assessment of individuals. Regarding public laws: know where to obtain the information; how laws affect families and professional practice. How to define a new role in an unfamiliar system. Know how to write proposals. Know how to work in client's home: have awareness of ecological approach to viewing families; family managerial theory and practice; family developmental theory; affect of crisis on fami- lies' ability to adapt and cope. Have creative/practical problem-solving skills. Ability to assess and treat in a non-0T department setting - the home: comfort in lack of structure; ambiguousness; confi- dence in one's self and professional skills. Work as an interdistiplinary team member: share professional knowledge and skills; possess good interpersonal relationship skills; have holistic approach to client and be able to set priorities based on client's needs. Be able to communicate clearly, precisely and in terms lay person can understand, OT theory, philosophy, and practice. Know how to document client information according to quality assurance standards. Engage in studies of the evaluation of service outcomes to assess quality of service performed. 228 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 229 Have administrative skills (as defined by Johnson, Jerry, "Report on Analysis of Examples of Performance Containing Administrative and Educational Implications," unpublished Master's report, Harvard Graduate School of Administration). a. Training and experience in analytical processes; human relations and personnel administration: organization and standardization of office procedures; analysis of jobs for delegation purposes. Understanding needs of persons employed on staff; limitations to the imposed; explanation of roles and role expectations; supervision of staff and staff evaluation. Training methods. Communication systems - written and spoken - that is effective within and outside department. Understanding of group processes and methods to change behavior of persons. Methods for motivating persons to higher achievement levels. Training in specific office procedures. Training and experience in verbal communication. Training in educational techniques. Training in evaluating action. (DQOU' Know how to consult; possess good consultation skills and those of change agents. Ability to teach or instruct others: determining learning objectives, appropriate learning strategies and evaluations for measuring learning. Awareness of community resources and information seeking process. Ability to live with ambiguity. Know how to negotiate an unfamiliar system. Have effective public relations skills. Understand uniqueness of OT and be able to communicate it clearly and simply; be able to relate the uniqueness of OT to specific community systems. Have knowledge of specific handicapped populations such as those within the school system; know how to assess and treat and conform to needs and requirements of the system. Be familiar with union politics and professional liability. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 230 Know how to influence the legislative process in all phases of law making and implementation. Be able to accept the responsibilites of an independent practi- tioner. Engage in research to substantiate that what OT does results in benefits over costs to client. Have leadership skills. Have knowledge of social effects of technolo on quality of life; forces (economic, political and social that control individual goal attainment and influence family decisions. Know why persons behave as they do; how behavior is determined; how to motivate persons to do something to prevent what does not exist (in preventative care). Acquisition of professionalism over ana above technical skills. Knowledge of evaluation methodology, quality care review, cost- benefit analysis. Know how to engage in program development: planning, gathering data, setting goals and priorities, making decisions, and imple- menting action. Have awareness of total health care arena and place of OT within. Competencies from the Review of the Literature 32. 33. 34. 35. 36. 37. Skill in individual counseling, budgeting and finance; adult education; community organization and development; administration and management. (Ethridge, 1976) Keeping informed about current legislation, benefits, services available to clients such as the geriatrics population. (Lewis, 1975) Ability to be a client advocate in various systems; represent client in hearings, educational planning and placement committees. Ability to apply OT theory and practice to a variety of popula- tions: young, chronically ill, severely handicapped and "normal." Knowledge and skill to develop and implement private practice through home health services in the community. (Ford, 1971) Be a community health specialist who can move into nontraditional settings and develop programs - know the Discovery Process for assessing communities. (Cromwell & Kielhofner, 1976) 38. 39. 40. 41. 42. 231 Skill in research, administration, and professional involvement in health care policy making. (Maxwell, 1977) Be cognizant of environmental psychology which looks at people, space and tasks, and their interrelationships. (Dunning, 1972) Knowledge and skill in political and financial matters. (Johnson, 1976) Serving community to prevent disability and dependence. (Johnson, 1976) Knowledge of basic principles of measurement and testing; teaching-learning. (Mosey, 1974) Competencies from OT 2001 43. 44. 45. 46. 47. 48. 49. Ability to contribute to the fundamental management of human living. (Wiemer, 1979) Ability to develop and obtain an activity histor and a per- formance evaluation. (Hightower - Vandamm, 1979 Knowing the importance and use of activities throughout the life-span of persons. (Hightower - Vandamm, 1979) Possessing characteristics that allow an OT to practice inde- pendently as a health professional. (Johnson, 1979) Being a catalyst for helping people solve complex problems of functioning in a highly technical society. (Cromwell, 1979) Being professionally socialized to the values the profession espouses. (Yerxa, 1979) Possessing a professional identify which includes skepticism, initiative, scientific inquiry and professional and ethical ideals. (Gillette, 1979) Competencies from Consultation in the Community: OT in Child Health 50. 51. Skills of the consultant, supervisor, researcher. (West, 1967; p. 3 Being a health agent: helping normal growth and development with emphasis on prevention; serving health needs of persons outside hospitals. (West, 1968; p. 10) 52. 53. 54. 55. 56. 57. 58. 232 Ability to plan for health services that concentrate on preven- tion, both primary and secondary (prevent illness and disability, pursue activities aimed at early detection and dysfunction). (West, 1969; p. 19) Doing research on affects of lack of activity on health; rela- tionship of impact of environmental stress on individuals' health; development of data and tests unique to the profession. (Weimer, 1972; p. 26) . Ability to think creatively - use one's imagination. (Finn, 1972; p. 38) Possessing a comprehensive knowledge and understanding of meaning and significance of activities in the development of man's fullest potential; application of activities to provision of improved quality of life. (Finn, 1972; p. 38) Ability to be leaders; move in confidence into the community, contribute knowledge of activities and human action. (Finn, 1972; p. 38) Ability to problem solve: identify service, develop program objectives, implement programs, review programs, develop new . objectives, implement needed changes. (Llorens, 1972; p. 71) Skills and knowledge needed to facilitate optimal growth and development; within other cultures and in settings outside the hospital, in role of health agent. (Llorens, 1971, p. 84 Competencies from Additional Review of the Literature 59. 60. Knowledge and skills in growth and development of the total life span, sorking with families, teaching families and members of other disciplines, systems that impinge upon developmentally disabled persons, legal and human rights, community resources, mechanisms for coping with the political arena, pro ram planning and evaluation and advocacy. (Moersch, 1978; p. 93? Knowledge of the adaptive process as a theoretical framework applie? to all specialty areas of OT practice. (King, 1978; p. 429 APPENDIX B TABLES OF VARIABLES Table B-L Variables, convergence to consensus, semi-interquartile range, and frequencies for Rounds One and Two. Semi-Interquartile 7Convergence to Variable Range Consensus Means Number Round 1 Round 2 Round 1 Round 2 Round 1 Round 2 l .348 .348 .845 .845 4.68 4.68 2 .554 .332 .713 .875 4.42 4.75 3 .662 .534 .650 .714 4.18 4.43 4 .588 .414 .673 .825 4.34 4.65 5 .992 .880 .487 .594 3.09 2.61 6 .513 .331 .765 .862 4.53 4.73 7 .778 .605 .556 .677 3.21 3.14 8 .688 .398 .665 .799 3.90 3.91 9 .713 .442 .634 .751 3.89 4.02 10 .887 .829 .547 .572 2.56 1.86 11 .330 .330 .865 .865 4.73 4.73 12 .886 .671 .159 .633 3.21 3.13 13 .666 .443 .648 .779 3.69 3.77 14 .570 .503 .709 .762 4.22 4.39 15 .327 .327 .875 .875 4.75 4.75 16 .454 .454 .804 .804 4.61 4.61 17 .562 .301 .697 .890 4.39 4.78 18 .491 .491 .774 .774 4.55 4.55 19 .573 .332 .686 .855 4.37 4.71 20 .580 .412 .680 .833 4.31 4.67 21 .335 .335 .864 .864 4.73 4.73 22 .457 .457 .806 .806 4.61 4.61 23 .574 .383 .683 .835 4.37 4.67 24 .466 .466 .801 .801 4.60 4.60 25 .510 .288 .766 .934 4.53 4.87 26 .530 .297 .739 .905 4.48 4.81 27 .659 .611 .623 .655 4.05 4.19 28 .749 .448 .601 .741 3.90 3.87 29 .618 .490 .680 .790 4.14 4.34 30 .612 .422 .683 .805 4.05 4.15 31 .702 .380 .649 .820 3.91 4.07 32 .696 .408 .646 .808 3.98 4.13 33 .581 .427 .694 .825 4.21 4.24 34 .630 .550 .664 .717 4.21 4.35 35 .718 .546 .641 .737 3.94 4.19 36 .712 .570 .581 .704 3.54 3.67 37 .729 .512 .621 .751 3.75 3.83 38 .661 .393 .648 .807 3.98 4.12 39 .833 .425 .563 .772 3.66 3.99 40 3.875 .690 .547 .619 2.65 2.42 41 .691 .597 .624 .658 3.63 3.40 42 .792 .419 .559 .759 3.09 3.02 43 .758 .579 .555 .681 3.44 3.35 44 .819 .424 .568 .740 2.99 2.89 45 .929 .571 .507 .697 3.20 3.19 233 234 Table B-1. (Continued) Semi-Interquartile Convergence to Variable Range Consensus Means Number Round 1 Round 2 Round 1 Round 2 Round 1 Round 2 46 .710 .341 .623 .846 3.78 4.00 47 .838 .679 .578 .642 3.79 3.73 48 .716 .473 .609 .740 3.62 3.89 49 .825 .424 .575 .747 2.89 2.89 50 .744 .623 .572 .656 3.51 3.58 51 .722 .534 .586 .736 3.51 3.72 52 .618 .370 .665 .809 3.84 3.96 53 .718 .383 .632 .805 3.88 4.00 54 .754 .580 .617 .693 3.91 4.25 55 1.263 1.174 .380 .417 2.85 2.65 56 1.245 .707 .398 .636 2.57 1.73 57 1.175 .991 .417 .515 3.02 2.41 58 .823 .432 .580 .726 3.78 3.91 59 .932 .317 .500 .822 2.00 1.36 60 1.071 .589 .449 .690 3.30 3.49 61 1.053 .426 .469 .770 2.20 1.46 62 .535 .279 .741 .939 4.48 4.88 63 .613 .443 .653 .727 3.96 3.73 64 .967 .305 .526 .858 2.20 1.28 65 .717 .379 .617 .803 3.81 4.04 66 1.117 .891 .445 .592 2.55 1.82 67 .739 .406 .592 .749 3.72 3.80 68 1.054 .769 .468 .548 3.09 3.11 69 1.279 1.105 .402 .458 2.67 2.18 70 .706 .372 .630 .808 3.78 3.94 71 1.196 .914 .436 .592 2.57 1.82 72 1.065 1.103 .485 .465 2.82 2.35 73 1.115 1.115 .448 .465 2.95 2.93 74 .999 .753 .513 .648 2.85 2.62 65 .837 .461 .547 .745 3.59 3.75 76 .665 .506 .647 .763 4.02 4.26 77 1.032 .399 .486 .764 2.09 1.47 78 1.047 .868 .473 .547 2.33 1.93 79 1.109 .938 .482 .536 2.73 2.24 80 1.151 1.024 .441 .518 2.99 2.82 81 1.073 .966 .463 .507 2.55 2.27 82 1.298 .975 .393 .493 2.75 2.03 83 1.180 .911 .430 .542 2.69 1.92 84 1.178 .554 .426 .689 2.29 1.62 85 1.093 .368 .464 .751 2.18 1.50 86 1.200 .752 .397 .636 2.48 1.73 87 .952 .464 .521 .702 2.97 2.85 88 .484 .484 .776 .776 4.55 4.55 89 1.192 1.019 .440 .489 2.80 2.17 90 .976 .407 .434 .768 3.35 3.97 235 Table B-1 . (Continued) Semi-Interquartile Convergence to Variable Range Consensus Means Number Round 1 Round 2 Round 1 Round 2 Round 1 Round 2 91 1.159 .569 .471 .666 2.81 3.10 92 1.054 .556 .486 .645 2.96 2.87 93 1.075 .474 .491 .735 2.69 3.15 94 .730 .287 .616 .901 1.77 1.20 95 1.194 .982 .408 .504 2.53 2.01 96 .538 .264 .724 .971 4.45 4.94 97 .445 .445 .805 .805 4.61 4.61 98 .654 .505 .633 .770 3.99 4.24 99 .626 .467 .644 .798 4.17 4.60 100 1.010 .718 .516 .646 2.82 2.61 101 .551 .284 .731 .921 4.47 4.84 102 .540 .282 .731 .921 4.47 4.88 103 .653 .535 .640 .714 4.06 4.43 104 .610 .507 .676 .765 4.21 4.53 105 .634 .504 .651 .763 4.08 4.53 106 .460 .460 .810 .810 4.62 4.62 107 .570 .509 .706 .742 4.18 4.49 108 .588 .516 .741 .697 4.17 4.46 109 .594 .326 .665 .860 4.33 4.72 110 .677 .349 .643 .845 3.92 4.12 111 .605 .495 .682 .770 4.26 4.54 112 .566 .327 .710 .869 4.42 4.74 113 .595 .489 .697 .784 4.11 4.32 114 .849 .687 .528 .608 3.42 3.32 115 .928 .621 .494 .644 3.47 3.39 116 .604 .530 .647 .728 4.23 4.46 117 .604 .481 .637 .753 4.28 4.51 118 .598 .352 .657 .821 3.98 4.04 119 .548 .367 .701 .827 4.40 4.65 120 .737 .360 .595 .783 3.79 3.72 121 .811 .623 .504 .621 3.29 3.23 122 .767 .540 .573 .709 3.51 3.55 123 .609 .560 .660 .716 4.19 4.43 124 .860 .709 .508 .544 3.36 3.20 236 Table B-2. Listing of inventory competency statement with corres- ponding variable number. Variable Variable Variable Number Number Number Number Number Number la 1 Si 43 7ee 86 1b 2 5j 44 7ff 87 1c 3 5k 45 799 88 1d 4 51 46 7hh 89 1e 5 5m 47 7ii 90 1f 6 5n 48 7jj 91 lg 7 50 49 7kk 92 1h 8 711 93 11 9 53 50 7mm 94 5b 5‘ 7nn 95 2a 10 6c 52 700 96 2b 11 6d 53 7pp 97 2c 12 6e 54 2d 13 7qq 98 2e 14 7a 55 7rr 99 7b 56 75s lOO 2f 15 7c 57 8a 101 3a 16 7d 58 8b 102 3b 17 7e 59 8c 103 3c 18 7f] 60 8d 104 Be 20 7g 62 8f 106 3f 21 7h 63 8 107 3g 22 71 64 9 8h 108 3h 23 7j 65 81 109 31 24 7k 66 8 110 33 25 71 57 Bfl 1]] 31 27 7n 69 8m 113 3m 28 7o 70 8n 114 3n 29 7p 71 7q 72 9a 115 2: 3? 7r 73 9b 115 4c 32 7s 74 9c 117 4d 33 7t 75 9d 118 4e 34 7u 76 9e 119 7v 77 9f 120 5a 35 7w 78 99 121 5b 36 7x 79 9h 122 5C 37 7y 8O 91 123 5d 38 72 81 93 124 5e 39 7aa 82 5f 40 7bb 83 59 41 7cc 84 APPENDIX C PARTICIPANT CORRESPONDENCE MICHIGAN STATE UNIERSITY College of Education East Lansing, MI 48824 Department of Administration and Higher Education Erickson Hall January 16, 1980 ' Dear Colleagues: For the last few years I have been a doctoral student and am now at the dissertation stage. With a strong commitment to the field of occupational therapy, I have chosen a dissertation topic which will contribute to the field; it is The Identification and Validation of Occupational Therapy Competencies. I shall also design a model of lifelong professional development which will describe the process of competency acquisition. The relevance of this study is supported by two recognized leaders in our profession. Jerry Johnson, past president of A.D.T.A. has stated that 01's are often reactive when they need to be pro- active, and that we must do something now to direct the course of the profession. Ruth Wiemer wrote in Occupational Therapy: 2001 A.D., that the profession is moving from traditional to transitional to contemporary practice. She reports that contemporary practice requires skills, knowledge and attitudes (competencies) different from former practice. In order to realize the contribution to occupational therapy which this study will make, I need your assistance. Since this is a Delphi study which uses a panel of experts to provide opinions about specific items, I would like to have you accept the role of panelist. You will receive two rounds of an Occupational Therapy Competency Inventory. The inventory which is included with this letter contains competencies taken from the Essentials of an Accredited Educational Program for the Occupational Therapist, a review of the literature and implications from social policy legislation. In Round I, panelists will give their opinions about the essentiality of each competency and add competencies to the original list. In Round II, feedback will be given regarding the responses from the first round and you will be asked to review your opinions about each competency or state your reasons against doing so. The goal is to obtain consensus on the essentiality of competencies for entry into the profession. To summarize, you can assist me in the following ways: 1. Completing the Occupational Therapists Competency Inventory by giving your opinion about competency- essentiality, and adding to the list of competencies. Completing the one page of personal data information. Returning the completed Inventory to me by February 8, 1980. 4. Repeating this process in Round II which will be sent to you in February. DON 237 238 Page 2 January 16, 1980 Please be assured that complete confidentiality will be main- tained regarding your responses at all times. Only your names as panelists will appear in the final study summary. If you are unable to be a panelist in this study, please return the Inventory in the enclosed self-addressed stamped envelope. I am sending you the reference list which covers my review of the literature. Thank you in advance for your support of this study and the advancement of the profession. Sincerely, Virginia K. White, M.A., OTR 133 Kenberry Drive East Lansing, MI 48823 239 BLUE SHEET MICHIGAN STATE UNIVERSITY College of Education East Lansing, MI 48824 Department of Administration and Higher Education Erickson Hall March 20, 1980 Dear Colleague: Thank you for completing the OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY in Round #1. I really appreciate your help very much, knowing how busy you are. There was a good return which will supply valuable data for committees of AOTA studying the Essentials for Accreditation and Recertification and for university curricula. Your final contribution will assist me to complete my doctoral program, but more importantly should yield lasting benefits for our profession. As mentioned in my first letter, a second round is required by the research technique I am using - the Delphi procedure. Opinions and competencies are given by panelists in the first round. The overall goal is to obtain as large a degree of consensus or agreement about the competencies as is possible. In order to work within time constraints, please try to return the INVENTORY completed within two weeks after receiving it (or later if absolutely necessary). If time is limited, be sure to complete Part #1 because it is necessary for identifying the priorities in the field. Your comments are greatly appreciated and will appear in the summary without identification. I will send you a summary of the study upon completion if you indicate you want it (see last page of INVENTORY). Again, if you have questions, please call collect at (517) 351-6806. Thank you for your support of this study. Sincerely, Virginia K. White, M.A., OTR 240 February 5, 1980 Dear Colleague, Your assistance is needed desperately in answering the OCCUPATIONAL THERAPY COMPETENCY INVENTORY sent to you in January!! If you have already returned the INVENTORY, please ignore this reminder. If not, please complete and return as soon as possible. The more replies received, the more valid will be the results of this research and greater the benefits to the profession. Thank you again for taking time from busy schedules to parti- cipate in this study. Virginia K. White 133 Kenberry Drive East Lansing, MI 48823 517/351-6806 April 21, 1980 Dear Colleague, Your assistance is urgently needed in respondin to Round #2 of the OCCUPATIONAL THERAPY COMPETENCY INVENTORY ?blue paper) mailed to most of you on March let. If you have already returned the INVENTORY, please ignore this reminder. If not, please complete AT LEAST PART I and return immediately. To ensure the validity of this research which will contribute to the discussion of current professional issues, I need responses from all who participated in Round #1. Thank you again for giving valuable time to this study. Virginia K. White 133 Kenberry Drive East Lansing, MI 48823 517/351-6806 241 OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY 1. Name SECTION II: PERSONAL DATA EDUCATION Check ( ) degree(s) that apply Bachelor of Arts/Science (2 Master of Occupational Therapy (3) Certificate in Occupational Therapy E4; 5 Bachelor of Science in Occupational Therapy (1) Master's in 0‘01th please specify _____Ph.D. in (5) please specify 8. Certificate of Candidacy for Ph.D. (7) \l PROFESSIONAL DEVELOPMENT (8) Have you participated in any continuing education workshops, courses or conferences in the past year? Yes (1) No (0) EMPLOYMENT (9) Are you presently employed? Yes (1) No (0) Number of years worked as an OT in total (1) less than 5 years 5 - 10 years 11 or more years CON-J ARE YOU CURRENTLY EMPLOYED IN AN OT POSITION IN ANY OF THE FOLLOWING SETTINGS? (11) Check principTe one only. 1. Hospital (general or mental) or Rehabilitation Center. 2. Other: School System Private Practice Home Health Agency Residential Care Facility University Education Program Other (”Nam-DUO please specify 242 OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY (Continued) WHAT IS YOUR PRIMARY WORK FUNCTION? Check ( ) Qfl§_ (l2) Administration/Supervision Consultation Direct Client Service Teaching in Classroom or Field Other macaw—- o o o o o please specify CHANGE OF EMPLOYMENT SETTING (13) All things being equal, would you consider taking a job in a setting other than a hospital or rehabilitation center? Yes (1) No (0) If yes, what would cause you to change? (14) Want to develop your own job (1) Interest in non-traditional setting (2) Desirable client population (3) Because job is available (4) Other reason(s) mwa—a Please specify THANKS AGAIN FOR YOUR TIME. PLEASE RETURN TO: Virginia K. White, M.A., OTR 133 Kenberry Drive East Lansing, MI 48823 243 Form for Critique of OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY by Pilot Test Reviewers PLEASE RESPOND TO THESE QUESTIONS REGARDING THE OCCUPATIONAL THERA- PISTS COMPETENCY INVENTORY. 1. How long did it take you to complete the questionnaire? less than 1 hour 1 - 1; hours 1; - 2 hours 2 - 3 hours 2. Was the format easy to follow? very easy somewhat easy difficult: if sop why please specify 3. Were the directions for responding to the inventory clear and specific? yes no 4. Which competencies were not stated clearly? Please identify by competency number. Did you make comments in the comment column when they were unclear? Competency numbers: 5. Did you list additional competencies under each category when you thought they were needed? yes no 6. Did you suggest any changes in the cover letter? yes no 7. Did you suggest any changes in the directions for completing the Occupational Therapists Competency Inventory? yes no 8. ADDITIONAL COMMENTS? (Use back if necessary.) THANK YOU!! APPENDIX D SAMPLE OF ROUND TWO INVENTORY APPENDIX D SAMPLE OF ROUND TWO INVENTORY 8. PERSMAL PERFMNCE SKILLS avg ATTITUDES u. Deemstrate ability to accept constructive criticism and use it for self and/or professional grwth. THANK you son TAKING TIIE T0 CUTTRIBUTE YM OPINIMS TO THIS STUDY. I APPRECIATE YWR HELP VERY RICH. IF Yw DESIRE I WILL SEND YOU A SlfllARY G" THE STUDY UPON CMLETIGI. CHECK I'ERE YES Please return the OCCUPATIWL THERAPISTS CWETENCY INVENTNY to: Virginia K. bhite. M.A., O.T.R. Room I? Hanan Ecoloy Building Michigan State University East Lansing. MI 48824 Additional Counts? OCCUPATIONAL THERAPISTS COMPETENCY INVENTORY Round II Date Last ‘First Address City State Zip Telephone 4] Area Code ’Niiber This is Romd 02. The Purpose of this romd is twofold: first. to give you feeaack on the judgnents of panelists on cowetencies from Romd fl; second. to obtain opinions about the essentiality of additional oometencies submitted by panelists in Round 01. NEW FEATURES: 1. Each of the cowetencies included in Round '1 has printed in the rating coll-I1 a bar graph showing frequency of responses in each of the five colums and the seen of the ratings for that cometency. 2. (id-petencies which have reached 661 consensus of better are so lurked. These no NOT have to be rated a second tin. 3. There are two parts to the INVENTORY: -Part n contains coupetencies from Round '1. There have been changes to clarify wording; explanatory statements have been added to son coupetencies; a few coupetencies have been separated into two or non parts; however, the original oometency's rating is given in each calm. -Part '2 contains the oowetencies which were sent by panelists in Round 01. HHATTODOHEXT: 1. Refer to the bar graph to see how the panelists rated the essentiality of cowetencies that have not reached consensus. 2. Considering the frequency of the clarifying information and explanations. decide how you now want to rate these cowetencies. Mari: the appropriate colum. If you choose to differ significantly from the njority (if such exists). state why you have made that decision. 3. Read throu¢1 eaoh onetency statelent in Part 02 and like a Judgnent about the degree of essentiality you give that conetency. REHEFBER: These cowetencies apply to out into the rofession. irregardless of whether this is from a bacca- laureate or easter's program. 5y asslmlng a ran! of 5. 4. 3. 2. or 1. you are indicating how inortant you think each coupetency is for entry into the profession. If you indicate '5." you are saying that you think that coupetenc rates first priority: if you indicate a '1,“ you are saying that you think that cowetency is usefu . but has the lowest priority and is not necessary for entry level. TURN THE PAGE FOR DEFINITIINIS AND EXPLANATIONS. 244 245 PLEASE BE SURE TO DO AI LEASI PART #1. IT IS CHIILAL TO THE RESEARCH. EKPLANATIONS AND DEFINITINS -How the competencies are stated: the statements of knowledge, skill and attitudes which comprise the competencies are general goals or outcomes of learning and NOT performance or learning objectives (which have a stated behavior to be changed, conditions for completing the learning effort and a standard by which the learner's performance will be Judged . -Each statement should be preceded by the following: 'the student shall be able to ....... ." -Whether a competency is uasurable or not is a problem to be dealt with in writing the learning objective. -wny include the competencies for Occupational Therapy within the School System? Because few conpetencies have been identified through research study of energing areas of practice in occupational therapy. this research study that emanated from AOTA in 1979 was chosen to obtain youropinions about the importance of the competencies for entry level into the profession. -Use of the concept of “Wellness": from the World Health Organization's definition of health--"Health is a state of complete physical. mental and social well-being, and not urely the absence of disease or infirmity.“ " mlete" may be defined differently and isn't a universal. static, unattainable. absolute measure since it is often affected by some unalterable environmental, genetic. other factors. “Wellness” focuses positively upon how and what we eat, breathe. how we use our bodies. our ability to relax. to express ourselves, to be creative, to stand up for ourselves; how we manage our emotions, our tensions. our thinking. our relationships. Wellness emphasizes being responsible for who we are, our behavior. and our feelings. It is a dynamic state of assessing and self-correcting. surveying opinions. and making decisions. From a we lness perspective. illness (when it occurs) can be viewed as a positive life force--a cwmunicative opportunity to examine and readjust the balance among emtional, mental, physical andspiritual needs. Wellness is maintaining and being responsible for a balanced energy system.” (Mayer. 1980). Duality of life and life satisfaction: from Cambell, Converse. and Rodgers. University of Michigan: ”quality of life is a function. not only of Die objective characteristics of a person's situation but also of one's expectations and aspirations“: the relationship of happiness or satisfaction with life concerns to the subjective inportance of these concerns. Life satisfaction nasunes refer to individual perceptions of emtional, psychosocial. physical. educational lwork well-being and the wility to cope or adapt as needed. - ynamics of Occupation: see Wiener, Ruth. Basis of OT--the Impact of Occupation on the Hanan Being in OT: 2001. pages 45. 46. -Therapeutic Activities: see Resolution 1. the OT Newspaper, February 1980. -Tneories of Family Oevelo nt and Hana nt: family development theories consider life periods. stages and the develop- rental tasks un one to those stages in the lives of families; this differs from individual developmnt by con- sidering the interactional nature of the family embers. Managerial theory refers to systems theory applied to families and considers the input of resources. processing of goods and services. and the ongoing management of family goal-related activity. Ecological approach views families as systems of interacting and interdependent lenbers within the envimnnent o a y an e other pertinent environments of work, play. education. etc. - gcific activities and life tasks refer to their use in occupational therapy treataent. - ife space includes the individual's cultural background. value orientation and physical and social environIIent. -Client care studies or atient care studies are those studies conducted to evaluate the outcoles of OT service as a WWWf quality to apply and docmnt normative standards of OT service. -Self-care: According to the Uniform Terminology S tem for reportin OT Services (AOTA, 1-17-79). self care is a part of physical daily living skills ( ng. and hygiene. eeding/eating and dressing). Functional ability and object nnipulation are also listed wider the physical daily living skills. 2 246 THIS IS PART f1. IF YOU HAVE TO NAKE A CHOICE. ELEESE DO EARI £1. OCCUPATIONAL THERAPISTS CUIPETENCY INVENTORY (Round 02) Check (I) the calm to the right which best identifies how essential or iaportant is each competency for ENTRY LEVEL. Please at least do Part 01. which is necessary for identify—ing priorities in the field. SPECIFIC LIFE TASKS AND ACTIVITIES Analyze the processes involved in selected tasks and activ- ities (self-care. work. play/leisure) and other lifestyle activities in terms of the following skills and perfomnce: physical. sensorimtor. cognitive. Psychological. social. cultural , and economic. Comnents I Sufficient consensus achieved . no NUT RATE. Mean - 4.69 Relate specific life tasks and activities to client's abilities. limitations. goals, life satisfaction and lifestyle activities. (Specific life tasks and activities are those considered for treatment program.) than I 4.62 Relate the elmnts of any task or activity to age-specific needs. capacities and life roles. Mean . 4.18 Analyze and integrate developaental tasks. daily activities. and skill developunt in the performance of activities. lumen - 4.34 247 SPECIFIC LIFE TASKS AND ACTIVITIES miserve, identify and analyze tasks and activities rformd by clients through use of a variety of simlation sgategies such as audio-visual aids. role playing, teaching and self- 3:313:20", as opposed to direct diservation in the real Tl. Identify and analyze tasks and activities in terms of the following components: physical. sensorimotoncognitive. psychological, social. cultural. and economic. Analyze real or symbolic aeanin of acti i 1 by clients). 9 V t 95 (as perceived Relate social role behavior (necessary for life roles) and skills.in self-care. work and play to the develophent of a person s competence and potential. Perform basic life tasks and activities in areas of self- care. work and play/leisure. (This applies to the OT performin as a basis f 1 to teach others.) 9 °" P9 "9 able Mn - 3.89 BBIC HWN SCIENCES I” Explain family managerial theory (systems theory applied to families), its application to resource allocation. goal setting and family decision-making. Mean - 2.56 Know the human growth process: biological development and reflex reaction maturation; perceptual. sensorimtor. cognitive systems: emotional and intellectual develop- ment; social and cultural systems. Sufficient commenaue achieved. N NUT RATE. than I 6.73 Describe a person's interaction and interdependence with family and oomunity ushers. (The ecological approach views people interacting and being inter-dependent within systems.) Demonstrate knowledge and understanding of the client's social-cultural system and the interrelationship with individual developmnt and functioning. lean - 3.21 than - 3.69 Demonstrate knowledge of development of hunn personality and cognition. has: - 4.22 e. 1. Knowledge of development of personality. e. 2. Knowledge of developnnt of cognition. 248 BASIC HUMAN SCIENCES Conments Demonstrate knowledge of the structure and function of the barren body and body systems. Nervous system (central, peripheral. special senses) Sufficient consensus achieved. DO NOT RATE. Mean I 4.75 Husculoskeletal system Endocrine system Integunentary system Castro-intestinal system Genito-urinary system «dean-0.4.4.4. mama... Cardiopulmonary system m V 0 0'! b (A) N as e m s I e e I O Respiratory system OCCUPATIONAL THERAPY THEORY A PRACTICE: DIRECT CLIENT SERVICES Instruct a client in how to carry out a pro ram of ur- poseful activities. 9 p (graded to function) Sufficient consensus achieved. DO NOT RATE. Iiean I 4.61 OCCUPATIONAL THERAPY THEORY B PRACTICE: DIRECT flENT SERVICES Apply OT theory. principles and concepts serving clients of all ages, with or without disabilities (including the elderly, the chronically ill, and the severely mentally and physically handicapped), following client evaluation. (These specific clients' needs are sorretires not addressed; OTs should know how to apply OT practices to these persons.) ban I 4.39 b. I. Apply OT theory. concepts and principles to serving clients with disabilities. b. 2. Apply OT theory. concepts and principles to serving clients without disabilities. Evaluate client's abilities and deficits to present a profile of functional living skills and to obtain an activity or occupational history. Sufficient consensus achieved. no not RATE. lean I 5.55 Develop a functional living program based on determined goals and objectives. needs and performance skills. in cooperation with client and/or family or guardian and other seabers of the treaurent or health-care team. Kean I 6.37 Facilitate and support the client‘s active participation and investrrent in the therapeutic activity program. "man I 4.3! 249 OT THEORY AND PRACTICE: DIRECT CLIENT SERVICES Comments Evaluate the client's response to treatment. assessing to measure change and/or development. (From effect of client's performance on functional skills: use standardized measurements when possible.) Verify assessments. share findings with client and team renoers, and make appropriate recommendations. Demonstrate knowledge of theories and principles of occupa- tional therapy by communicating (explaining) them clearly. and understandably to others, verbally or written. (To lay People or professionals) Record and report client data orally and in writing. clearly and precisely. Adapt environment/activities to meet client's goals and needs. (When appropriate) Conmunicate reconmendations for follow-up. referral, or termination, when appropriate. (Also receive referrals) .-.— Sufficient consensus achieved . DO NOT RATE. lean I 4.73 Sufficient consensus achieved. DO NOT RATE. Kean I 4.61“ Mean I 4.37 Sufficient consensus achieved . DO NOT RAIE. Kean I 4.60 lean I 4.53 Hean I 4.48 OCCUPATIONAL THERAPY THEORY AND PRACTICE: DIRECT CLIENT SERVICES Comments Fabricate equipment/adaptive devices to meet clients' needs. . 1, Fabricate equipment/devices. lean I 6.05 2. Know how to design equipment/adaptive devices to meet clients' needs. Evaluate effectiveness of client's program through client care studies and other means of accurately measuring treatment outcomes such as quality care review. and PSRO. Bean I 3.90 Apply purpose of adaptive devices and equipment to clients' needs: know where to purchase and how to adjust or adapt. n. 1. Demonstrate ability to select/provide devices appro- priate to client's needs and willingness to use. Heart I 4.1!. J. 250 HEALTH- ILLNESS-HEALTH CMTINU‘! Comments Apply measures (evaluations) of biological, social. and psychological well-being and recognize common signs and symptom of health and lack of health. (Measures are factors or criteria that indicate biological, social or psychological well-being.) than IMOS Demonstrated knowledge and understanding of the concept of “wellness" in terms of measures of biological. social, and psychological well-being; influences on state of and main- tenance of health and quality of life. (See definition of "wellness" and "quality of life.“) than I3.9I Relate occupational (activity) performance to health. developnental tasks of life periods (or stages). per- formance skills and life satisfaction. (Relate what a person “does" to his/her health. develop- mental tasks of each life period, personal skills and general satisfaction. Mean I 3.98 Demonstrate knowledge of the etiology, profession, nnagerent and prognosis of congenital and developmental defects and deficits: disease process and mechanism. (And life trams) Explain the effect of the conditions in "d" upon the develop- mental process, life tasks, goals. skills. roles. and optinl hunan functioning. (To lay persons and professionals) tiean Ib.2I than I 6.21 HUMAN DEVELOPMENT PROCESS II Conrnents Analyze the meaning of activity in the development of human potential and carpetence in occupational performance. Mean I 3.94 Analyze the influence of non-human environnent on normal skill development both in meeting or interfering with need satisfaction (to know what changes can be brought about in the client). (For example. very small house with a large family that allows very little personal space.) ‘iean I 3.54 Identify the basic concepts in the socialization process (development of human relationships, roles and values); explain the influence of family masters and significant others in this process. Heart I3.75 Explain the acquisition of developmental tasks through- out the life cycle. (As a factor to be considered in planning treatment program.) than I3.98 Relate occupational performance activities and skill comments 1tc‘rfthe acquisition of developmntal tasks throumout e. (Demonstrate by listing developmental task components. per- formance skills necessary and relating appropriate occupation- al perforlmnce needed for accomlishing developmental tasks.) Mean I3.66 251 mu DEVELOPMENT process Relate the meaning and impact of symbols pertaining to the culture. to people in general and unique to a person. to the symbolization process throughout the life cycle. Relate adaptational concepts and modes to individual per- formance and life style. Demonstrate knowledge of family developmental theories regarding life tasks and needs throughout the family life stages. Assess individual/family adaptive and opping potential at times of family crisis. Identify influences of measures of life satisfaction on individual/family goal setting. (Measures: criteria of life satisfaction; relation to motivation and reinforcement) Mean I 2.65 Mean I 3.63 ”C.“ ' 3.09 Mean I 3.44 Mean I 2.99 HLHAN DEVELOPMENT PROCESS I3 Apply environmental psychology's concept of the inter- relationship of a person. life space and task activity to a client's occupational performance in various settings. (What a person does in various settings. e.g. home. school. work Analyze the learning of adaptive skills necessary for accom- plishing developmental tasks essential to productive living. (Productive living: maintaining desirable quality of life.) Apply the adaptive process as a theoretical framework (King's) to all areas of OT practice. Analyze human behavioral theories including how behavior is influenced and how persons are ntivated. (Know the basic theories and be able to apply in client treaurent.) Apply the ecological approach (interaction and interdepen- dence of persons within family system) to individual! 1ffllily developmnt. the adaptive process and quality of e. Hun . 3.20 Mean I 3.78 Mean I 3.79 Mean I 3.62 Mean I I.” 2252? OCCUPATIONAL THERAPY THEORY Comments Analyze the dynamics of occupation (all activities in which one engages) in routine hrmran living as a force‘Tn normal uman ve opment I behavior: by the type and unique de- mands. nature of the occupational task and by human differ- ences such as age. economy. culture, climate, environment. and mores. (Force used as a 'factor.') - 3.51 Analyze the dynamics of occupation as a force in the equilibrium of health as it relates to individual functioning. ' 3.5] Analyze the distortion of occupation in the presence of illness. injury. dysfunction & deficits on living at or before birth S continuously througrout life. Mean ' 3.84 Analyze (in the management of illness. injury. dysfunction. deficits) the use of occupation as a force in identifying and assessing health problem. prescribed for goal achievement in human development and in the presence of pathology. Mean I 3.88 Apply a variety of OT theoretical frames of reference. (Facilitating change in persons and groups in OT practice.) Mean OCCUPATIONAL THERAPY rancnicc: INDIRECT CLIENT SERVICES I 3.91 Comments Function as a supervisor of staff (COTA's). volunteers. or students by teaching. scheduling work. maintaining records, interviewing and counseling. directing pal attaimnt. evaluating performance. (Supervisory skills are basic here.) Function as an administrator by providing administrative and supervisory leadership for OT programs, develOping, implementing, coordinating and evaluating program. offering and participating in staff development, setting priorities and scheduling work. (Administrative skills are basic here.) Analyze problem. situations, and jobs: organize work and delegate responsibility; determine program costs and pre- pare budgets. Establish effective public relations which reflect inter- personal skill sensitivity. appropriate assertiveness based on a feeling of self-confidence resulting from cowetence in OT skills and knowledge. Mean I 1.05 Mean ' 2.57 Mean ' 3.02 Mean Write proposals for funding of program in OT. and know where to obtain such funding. ' 3.78 Mean ' 2.00 \S 225i3 OCCUPATIONAL THERAPY PRACTICE: INDIRECT CLIENT SERVICES Cements .1. Function as a consultant regarding client treatment within an organization as a staff sember. .2. Function as a consultant to a system-retained for a contracted period of time. Build trusting. helping relationships with other professionals and non-professionals. clients and family caters. Conduct needs assessment. identify 8 clarify problem. (This applies to intervention in systems.) Sustain a consulting relationship (as a consultant to a system) which gives no supervisory authority nor guarantees acceptance of one's ideas. plans or developed program. (A consultant to a system works without guarantees.) Mean I13.3O teen I2.ZO Mean I4.48 "C.“ a 3. 96 Mean I2.20 OCCUPATIONAL THERAPY PRACTICE: INDIRECT CLIENT SERVICES Comments I7 16 Engage in problem solving at the request of oth er ro or non-professionals with whom one works by listen'i,ngf:rswsi"ma‘Is clarifying to obtain the real problem. Facilitate and participate in cornmunit health 1 anni and other community health activities.y p 119 Provide OT services which promote health racti c prevention of illness and disability. p es for Pursue activities aimed at detection of client sf n 1 locations such as home. schools and health agen‘c'Ies‘.I Ct on in ““1qu optimal growth and dove] in the m1, of health agent. Pmnt within all cultures (Know culturally unique factors which delay growth and development.) Mean I 3.81 Mean I 2.55 HQ.“ . 3. 72 Hun . 3.09 -Hean I 2.67 254 OT PRACTICE: INDIRECT CLIENT SERVICES Comments Identify commnity resources and know the information seeking nmcess in order to serve the client maximally. (Information seeking process: how and where to gather inform- ation about comnunity resources.) Assess (get a description of) communities and help others develop program that promote health. Apply knowledge of activity analysis in relation to persons' needs to the area of community health promotion. Adjust to working in non-OT department settings such as homes; live with ambiguity and lack of structure, if necessary. (Also be a self-starter). Apply knowledge of open and closed families to gaining access to a family and develop a trusting relationship. (Open family is easily accessible and open to intervention; closed families do not readily admit outsiders.) Mean I 3. 78 ---.— Mean I 2.57 m“ o 2.82 m Mean I 2.95 Mean - 2.85 OT PRACTICE: INDIRECT CLIENT SERVICES Comments 15 I9 Know AOTA standards of practice which apply to all areas including home health; know how to use quality assurance evaluation methods. Transmit the value of occupation in promoting health to clients and other professionals. Analyze social policy formation and the process of law enactment within the legislative system. v. 1. Know the price: of social policy fannitionm.raw - enactment. Mean I 3.59 ‘ w. --.¢.w . Erma - 4.02 "("1“ " 2.09 Demonstrate knowledge of how to influence the legislative process. mechanism for coping within are political arena, and where to obtain information about current legislation. w. 1. Now to influence the legislative process. "can I 2.33 w. 2. Know mechanisms for coping within the political arena. w. 3. Know where to obtain information about current legislation. 255 GT PRACTICE: INDIRECT CLIENT SERVICES Comments Analyze how economic. political and social forces affect individual goal attainment and family decision making and bear on the quality of life. Mean I 2.73 Function as an advocate for the handicapped person's human and legal rights; benefits and services needed. Demonstrate knowledge of the process of negotiating systems. applying this knowledge to school systems. vocational rehab- iltation and others. (Negotiating systems refers to learning how to get things done in unfamiliar systems.) Mean I 2-55 Apply scientific inquiry. methodology and scholarly writing to the development of OT theory and practice. Rean I 2.75 bb. Plan. conduct or assist with research such as substantiating that what OT's do results in benefits over costs to the client. or to establish relationships between the components of occupational performance. etc. fiean I 2.69 0T PRACTICE: INDIRECT CLIENT SERVICES Comments CC. As a researcher. be a link between practice and education. connecting these two areas of the profession. (Research based on input from practitioners can lead to changes in basic professional education.) dd. Function as a researcher by promoting research such as the effects of lack of activity on health; relationship of impact of environmental stress on one's health; the development of data and tests unique to the profession. etc. Mean I 2.29 . Engage by oneself or by cooperating with others in research for the benefit of the public and the growth of the profession. whether as a clinician. educator. administrator. or consultant. Help . 2.18 ff. Identify such concepts as the dynamics of occupation and apply to all areas of OT specialization. (Know how to apply to all areas. Dynamics of occupations are concepts of activity which serve as forces or influential factors.) Initiate and direct one's own professional growth on a continuing basis. Hem . 2.48 Mean . 2.97 Sufficient consensus achieved. DO NOT RATE. Been I 4.55 256 Comments 7. OT PRACTICE: INDIRECT CLIENT SERVICES hh. Provide leadership in the development of the profession. Help I 2.80 I ii. See the client's entire situationuthe overall picture; grasp the essential elements and assist others to formulate plans and take action to reach goals. Huh I 3.35 jj. Function as a change agent: persuade or mtivate pertinent persons to move in a desired directionurecognize the innova- tors. risk-takers. and early adopters. (Pertinent persons: those with whom therapist is working.) Nean'I2.BI kk. Function as a change agent by being a catalyst for behavioral change. and an innovator. assisting others to promote and initiate an innovation or change in a particular setting. ll. Assist clients to re-define their roles in order to par- ticipate in a desired change. Hun I 2.69 mm. Establish and maintain oneself as an independent prac- tioner (self-employed): seek. obtain. and write contracts. fiean I 1.77 Comments 7. OCCUPATIONAL THERAPV PRACTICE: INDIRECT CLIENT SERVICES nn. Narket oneself and professional services to organizations. families. agencies and others to obtain clients and promote recognition of the profession. mg. . 2,53 nn. 1. Market oneself and professional services. nn. 2. Promote recognition of the profession. oo. Maintain a level of professionalism which uses one's best Judgment in making decisions. (Professionalism: that which constitutes being a professional person.) Neon - 4.45 pp. Engage in sharing and linking with other professionals when Sufficient coneeneua achieved. in the best interest of a c ient. no NOT RATE. (To accowlish OT program objectives.) Mean I 4.61 qq. Demonstrate knowledge of personal liability. professional ethics. reimbursement for services and other necessary business practices. Mean I 3.99 rr. Articulate the uniqueness of occrpational therapy broadly and/or specifically as needed. Nean I ‘.17 2557 OT PRACTICE: INDIRECT CLIENT SERVICES Comments SS. Contribute to comprehensive health care services through knowledge of public health principles and procedures. (Including Crippled Children's Benefits. lelfare. iedicare and Medicaid.) PERSONAL PERFORMANCE SKILLS AN_D_ATTITUDES Demonstrate evidence of problem solving skills: how to per- ceive. analyze and ident y pro ems; eva uate and assess alternatives: abstract and generalize ideas; draw inferences. make deductions; interrelate and coordinate information; identify similarities and differences; perceive parts in relation to the whole; establish priorities and proceed in a logical sequence. using corlron sense and logic. Demonstrate written and oral communication skills by writing and speaking clearly, in an organized manner. focusing on appropriate and essential points; select and relate useful data. (So that all who read or hear can understand.) Man I 4.47 Act in an appropriately assertive. proactive and leadership manner among health professionals and others with whom one is in contact. Mean I 4.47 PERSONAL PERFORMANCE SKILLS AND ATTITUDES Mean I 4.06 24 25 d. Possess a professional identity which includes skepticism. (questioning), initiative. professional and ethical ideals. Mean ' 4.21 Focus on essentials. know what to look for. perceive inter- relationships from observation. (Observational and listening skills.) Man I 4.08 Perceive res nsibilit ; accept responsibility for own actions and Sgcisions; accept and follow through on appropriate responsibilities. (In relationship with others for god 0f POPU‘IIUOH served.) Sufficient consensus achieved. DO NOT RATE. "3.“ ' 4.62 Adjust to change; deal effectively witha simultaneous variety of experiences; modify own behavior thereby demonstrating flexibility and adaptability. Noun . 4.18 Perform concurrent tasks or assimments effectively: follow through in logical sequence and order; appropriately use struc- ture and flexibility; interrelate and correlate tasks and functions; appropriately organize time and set priorities. Hun . 4.17 Exhibit curiosity and drive to learn; commitment to the welfare of others. (Downstrating mtivation and commitment.) Mean ' 4.33 258 PERSONAL PERFUIMANCE SEILLS P62 ATTITUDES Comments Demonstrate resourcefulness and creativity by being a self-starter. se -re ant. an enterp s ng; formulate and develop independent ideas; be inventive and think rreativer; act upon and inlerent creative thought. Demonstrate self-awareness by working toward increased self-understanding; distinguishing our needs from those of others; be sensitive to own needs and feelings and how these affect others. “3.“ I 3.92 Demonstrate relatedness to others by being sensitive to needs and feelings 0? others; aimnstrating warmth and concern for others and having apprOpriate expectations of others; help others to be independent; earn respect from others; give a take. “P., _ 4.26 Demonstrate objectivity and judgnt by appraising situations realistically an Ject ve y: see things in proper proportion; tolerate error and/or failure in self; exhibit appropriate self expectations; self-assurance. belief and respect for self; withstand frustration. anxiety,disagreement and pressures. Demonstrate manual dexterity in the use and manipulation of tools. equipment and materials used in activities. ...___—.-... ..- - 26 OCCUPATIONAL THERAPY NITHIN THE SCHOOL SYSTEM Comments Demonstrate the ability to initiate and manage occupational therapy programs as defined by the service delivery patterns and ethical practices of the occupational therapy professsion and the laws. rules. and regulations of the school district served by the therapist. Assess an individual's (student's) functional capacities and limitations according to the student's educational level and needs. Mean I 4.23 Implement an effective occupational therapy program based upon results of assessments and educational needs of students. “C.“ u “.28 Demonstrate ability to engage in consensual decision nking as a part of the educational managenent program for planning and implementing programs to net identified functional needs and educational goals of the student. Document specific perforunce objectives as related to the individual's needs. progress. and program. Mean I 3.98 Mean I 4.40 259 OCCUPATIONAL THERAPY HITHIN THE SCHOOL SYSTEM ‘. Apply occupational therapy concepts to educational management programs as a basis for integrating occupa- tional therapy service programs into the educational system. g. Relate educational/health/social trends to occupational therapy concepts to develop/enhance/enlarge occupational therapy services within the educational system. Engage, as a health professional. in a consulting/training relationship with individuals within the educational system. Communicate the value of occupational therapy in inroving school performance of students to school personnel.parents and health professionals. j. Engage in a supervising/training relationship with other in- dividuals in implementing occupational therapy principles and theories. PLEASE CONTINUE HITH PART f3 PART '2 I. SPECIFIC LIFE TASKS AND ACTIVITIES Mean I 3.79 ' Mean - 3.29 ‘ Mean I 3.51 - Mean I 4.19 ‘ Mean - 3.36 2‘! LL The following competencies were submitted in Round ll. Please express your opinion as to the essentiality of each. 1. Determine client's priorities in specific life tasks and activities. k. Analyze and teach stress management. l. Relate theoretical base for activities to assessments and treatment for the specific theory. e.g. biological illness I Sensory dysfunction o sensory assessment o-physical inter- vention a gross motor activity; psycho-dynamic illness I developmental assessment + stage appropriate activity o treatment. m. Teach specific life tasks and activities to clients. n. Take an occupational history. o. Interpret occupational history and incorporate in treatnnt p an. p. Identify the priorities associated with selecting life tasks and activities for treatment of dysfunctions in physical. sensorimotor, cognitive. or psychological development. 260 SPECIFIC LIFE TASKS AND ACTIVITIES Comments q. Acquire sensitivity to the client's feelings in order to be better able to know areas of importance to the client as a help in initiating motivation. 2. BASIC HUMAN SCIENCES The following competencies were submitted in Round II. Please express your Opinion as to the essentiality of each. g. Integrate biological. psychological and social systems con- cerning a person's ability to perform. Demonstrate knowledge of pathologies of human physical. soc1al. psychological development and implications of those pathologies. Demonstrate knowledge of dysfunction of the human body and body systems. Demonstrate knowledge of how accepted forms of treatment for dysfunction work on the human body. Identify pathology in problems that interrupt or disrupt "normal“ development. BASIC HUMAN SCIENCES Comments 31 30 Demonstrate basic ability to read. write and argue logic- ally. as befits a professional. Explain the operational dynamics involved in systems theory. Apply neuroanatomy concepts in development and neuro- physiological correlates to the basic scientific structure for "wellness“ in the treatment of dysfunction. Demonstrate relationships of systems to each other in the human organism and to the organism's environment. Demonstrate knowledge of abnormal structure and dysfunction as it relates to the major diagnoses OTs treat. Analyze and apply the adaptation process as it relates to physiological. perceptual-cognitive and emotional- social development. Explain neurological structure and function in simple terms. Know how various structures and functions affect each other: for instance. how emotional responses affect the muscles. the gut. the sensory processing; how poor sensory processing affects emotions. etc. 261 2. IASIC HUMAN SCIENCES t. Know how nutrition affects body systems in prevention and control of dysfunction of the body (i.e. diabetes. hyper- tension. etc.). u. Demonstrate knowledge of abnormal types of psychological conditions and rehabilitation. v. Demonstrate knowledge of systems functioning and analysis. from the individual to the community (both within and be- tween systems). w. Analyze client's life space and relate to tasks and activ- ities (life space refers to one's various environments-- at home. work. play). x. Demonstrate knowledge of development of perceptual- motor function. y. Demonstrate ability to effectively deal with client's psychological needs and/or problems in all types of settings (in and out of institutions). 2. Demonstrate knowledge and understanding of basic learning theories. as. Demonstrate knowledge of neurodevelopmental stages and cognitive deveIOpment. ‘? 33 2. §ASIC HUMAN SCIENCES bb. Analyze the interrelatedness of the different body systems-- dysfunction in one is a strain in others. especially stress and the cardiovascular system. cc. Demonstrate knowledge of anatomy. neurology. physiology. kinesiology. and how they affect dysfunction. dd. Demonstrate knowledge and understanding of the psychological. psychosocial. and physical impacts of disability upon client and family. Demonstrate knowledge of the human aging process and its many implications. ff. Explain the physiological functions as they relate to behavior and/or abnormal psychological dysfunction. . Explain the psychological affects of disability. 262 Comments 3. OT THEORY AND PRACTICE: DIRECT CLIENT SERVICES 0. Initiate and/or participate in client follow-up programs after treatment terminates. when indicated. p. Generate referrals on clients who may benefit from OT services. q. Demonstrate ability to transfer safely. and position clients to facilitate activity. r. Record goals/objectives of OT program in measurable terms. 5. Relate to clients in service delivery in a manner depicting creative salesmanship--using positive body language. appearing interested. warm and vital. t. Demonstrate that all evaluation methods and treatment inter- ventions are derived from a theoretical base. showing rela- tionship between theory. principles of practice. and methods selected for goals to be attained. Possess a psychological understanding of oneself in con- ducting activities of therapy. Communicate clearly an apprOpriate home program to the client's family. or significant others in terms they can understand and by procedures they can implement. 0T THEORY AND PRACTICE: DIRECT CLIENT SERVICES Comments 35 Translate results of evaluation into measurable objectives (to demonstrate accountability). Demonstrate ability to carry out objectives in a variety of settings. i.e. OT clinic. client's home. community agencies. etc.. taking into consideration the differences in equipment. space available and time constraints. Demonstrate ability to rovide activities (for the treat- ment program objectives) that can be carried out by the client. a famfily member. aide or some other non-profes- sional person. and determine an appropriate plan for monitoring the program. Terminate client's program and write discharge summary. Apply the concept of occupational behavior to evaluation and treatment of clients. bb. Analyze treatment or intervention results. establish rela- tionships between problems identified and treatment approach. and redict outcomes of treatment to be utilized; then crit- ical y analyze results and modify. as necessary. theories or principles about OT treatment or intervention. CC. Recognize and accept client's right to a particular life- style. cultural pattern and personal dignity. 263 Comments 3. OT THEORY AND PRACTICE: DIRECT CLLIENT SERVICES dd. Demonstrate ability to work with families of clients. ee. Demonstrate knowledge of writing problem-oriented. S.O.A.P. notes. long term goals and objectives. as related to individual education plans (IEP's - school setting). clearly and precisely. ff. Explain how to base treatment programs on scientific inquiry. 99. mserve. record and evaluate non-verbal cues from client. hh. Demonstrate knowledge/awareness of community services! agencies and make clients aware of availability. ii. Demonstrate ability to measure wheelchair and select appropriate accessories. 33'. Demonstrate ability to adapt to patient's emotional state and adjust program to obtain optimal goals. kk. Demonstrate ability to assess patient's emotionsuexhibit sensitivity to patient's adjustment to disability. ll Engage in development of standardized tests for evaluation and assessment. 36 37 3. OT THEORY AND PRACTICE: DIRECT CLIENT SERVICES COW-ems Maintain open communication with all treatment team mem- bers to avoid overlapping and to verify those activities which are most beneficia . nn. Know a broad base of psychiatric and physical disabilities and what behaviors can be expected. Know basic pharmacology-drug effects on performance and expectations. DD- Demonstrate knowledge of thorouyr application of exercise routines appropriate to the diagnosis. QQ. Demonstrate knowledge and understanding of basic equipment and its application in patient treatment in OT departments. rr. Evaluate effectively the client's home situation. geograh- ical layout. routines. as well as family interactions and means of support. and plan for client's discharge and long term development. SS. Communicate clearly and personally to patients and their families--with professional honesty. tt. Demonstrate ability to adapt goals. based on OT theory and practice. to patient's goals and level of function. 264 3. OT THEORY AND PRACTICE: DIRECT CLIENT SERVICES Comments uu. Demonstrate ability to gather data/history information that is pertinent for assessment/evaluation. vv. Relate scientific background of OT education to providing neurodevelopmental treatment. ww. Relate the following factors to developing adaptive equip- ment: psychological. social. cultural and economic. xx. Apply OT principles to fabrication of equipment/adaptive devices. yy. Demonstrate ability to recognize one's inability to deal with a problem--personality or physcially. zz. Coordinate goals and objectives with other disciplines. aaa. Relate the psychological value of treating more than one patient at a time to OT practice: groups enable patients to observe others worse off and gives them an opportunity to learn they can do things. bbb. Apply theories such as Brunnstrom. Bobath. Rood. Ayers. King to clients in a “hands-on“ situation. 3. OT THEORY AND PRACTICE: DIRECT CLIENT SERVICES 38 39 Comments ccc. Demonstrate general knowledge of theories and methods of treatment used by other professional groups. e.g. physical therapists. speech pathologists. social workers. ddd. Evaluate client's home environment in terms of physical accessibility; client's ability to perform self-care and family-oriented skills in that environment. 4. HEALTH-ILLNESS-HEALTH CONTINUUH The following competencies were submntted in Round #1. Please express your opinion as to the essentialitv of each. f. Know different viewpoints. beliefs and values of health and the practices that accompany those viewpoints. g. Relate the role of stress in health-illness relationships. h. Analyze and apply adaptation processes upon the health- illness-health continuum. 1. Demonstrate a base knowledge of the pharmacology involved in the treatment of mental health disorders. j. Demonstrate a good working knowledge of behavioral medicine. 265 4. HEALTH- ILLNESS-HEALTH CMTINUUM J; .9 Comments k. Analyze the "concept of wellness” and relate to OT practice in preventive health. I. Know how emotions. sensory processing. and community inter- actions affect the wellness. health-illness continuum and how illness effects emotions. sensory processing. community interactions. etc. (the interactive effect). m. Possess an awareness of community special interest grows as resources on the health-illness-health continuum (e.g. arthritis foundation) and use their expertise and support for specific clients. n. Recognize effects of competency statement of Ad on family structure and psychological support. 0. List sources of information to determine diagnosis of patient in the health continuum (i.e. books. journals. etc.) . Demonstrate that function (a) maintains health; (b) lessens p impact of illness—-or retards its progress. and that dysfunc- tion can result in loss of health or aggravation of illness. . Inte rate physical and psychosocial dysfunction components q intoga health-illness-health. or function-dysfunction con- tinuum. ..-- - .... » -- ..———-- ‘- ...-....4 4. HEALTH-ILLNESS-NEALTH CMTINM Comments r. Identify the effect of neurodevelopmental treatrent on children with developmental delays as the treatnnt pro- cedure of choice and its underlying basis. 5. Explain the effect of sensory integration on children described in competency statement 4e. t. Become aware of various outside personal sources and facilities to use as resources in providing total patient care. u. Prioritize treatment interventions for the individual related to his/her health status and values. v. Demonstrate knowledge of the interrelationshi of psychological. biological and social health and IacE o? Ealth. 5. "WAN DEVELOPMENT PROCESS The following competencies were sibmrltted in Round II. Please express your opinion as to the essentiality of each. p. Describe/illustrate several different frames of reference for “Developmental Tasks.“ (Navinghurst. Erikson. Llorens. Levinson. etc. 21565 HUMAN DEVELOPMENT PROCESS Comments ' l Tasks" in assess- Use all frames of reference for Developmenta ing motive skills. occupational performance. etc. Explain the development process of the nervous system and the effect of stimulation to it. 1 process. with A l s choanalytic vieory to the developmenta pgggi’cfilir focus on skill attainnnt as it pertains to activity behavior. OCCUPATIONAL TH ERPAY THEORY d 01. The following competencies were srbmitted in Roun Please express your opinion as to the essentiality of each. Analyze critically the results of intervention based on analysis. Apply OT theories to clients througi first hand experiential situations. 7. or pnncrxcz: INDIRECTfiEEIENT SERVICES ., __ --..-- .. _ .41. .. Comments 42 43 The following competencies were sibmitted in Round 01. Please express your opinion as to the essentiality of each. Ct. Be able to teachothers (parents. family. teacher. etc.) how to carry out OT related programs. UU. Acquire knowledge and skill to appreciate. understand. and critique research. and analyze methodology of research articles. VV. Demonstrate an ability to document services rendered in a manner that clearly describes OTs unique contribution to the improvement of. or maintenance of optinl fmctioning. Demonstrate an ability to analyze a health program for clients. making sure it enhances optimal growth and functioning through proper use of activities. XX. Demonstrate ability to develop and justify charges for service. equitable to similar professions. YV- Demonstrate ability to develop basic policies. procedures and recording methods for one therapist departments using guidelines available from AOTA. 22. Know sources for supplies. and be able to order supplies and equipment. 267 7. OT PRACTICE: INDIRECT CLIENT SERVICES aaa. Be able to maintain tools. equipment and supplies (pre- ventive maintenance. proper storage and use. ffectively with b. Demonstrate ability to work efficiently and e bb other appropriate professionals to provide comprehensive. overlapping but not repetitive services. t and have an ccc. Describe the concept of change and change agen . opportunity to apply know e ge in relation to OT. ddd. Know the concept of marketing goods and services and how it applies to OT. ir . Know the medical care system and other health systems. the eee organization. manpower. purpose and relationship to OT. fff. Know how the regulatory system and regulations pertain to GT. 999. Have basic knowledge of management and organizational concepts and skills. hhh. Describe role delineation as a reference and resource to use in direct and indirect services. 8. PERSONAL PERFORMANCE SKILLS AND ATTITUDES Comments 44 45 The following competencies were added in Round ll. Please indicate your opinion as to the essentiality of each. o. Recognize contributions of others (by name and contribution) and not suggest that all statements pertain to therapists' own work and inventions. 0. Demonstrate an interest in learning and self-evaluation through supervision by a more experienced professional (preferable an 0T . q. 8e flexible in selecting needed equipment based on availability. r. Demonstrate knowledge of one's own strengths and weaknesses; obtain help when needed. and work to increase knowledge in weak areas. s. Demonstrate ability to work with people. understanding and accepting them as they are. t. 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