An Exploratory Study of Competencies for Emerging Practice in Occupational Therapy

Journal of Allied Health, Summer 2009 by Holmes, Wendy M, Scaffa, Marjorie E

Wendy M. Holmes, PhD, OTR/L

Marjorie E. Scatta, PhD, OTR/L, FAOTA

Many health professions face challenges and opportunities resulting in expanding contexts for service delivery. For the profession of occupational therapy, one element of this changing landscape is the ongoing development and delivery of services in new or underdeveloped practice settings, often identified as emerging practice. The purpose of this exploratory study was to identify the professional competencies needed for emerging practice and strategies for their development. The Delphi method of forecasting and exploration was used with a panel of 23 occupational therapists, currently practicing in emerging roles or settings, to gather specific information about the essential competencies and competency characteristics and to identify strategies for their future development. The Delphi panel identified 104 competencies essential to emerging practice and 55 strategies for the development of these competencies pertinent to occupational therapy educational programs and professional organizations. The study results are relevant to the educational preparation and professional development of health professionals for current and future practice roles and opportunities. J Allied Health 2009; 38:81-90.

IN RESPONSE to rising costs and policy shifts within the health care and social service systems, occupational therapists and other health professionals seek out opportunities to provide needed services in new practice arenas.1-5 These opportunities include serving populations frequently located in communities or other settings. Within the profession of occupational therapy, the expansion of practice areas is commonly identified as community-based and emerging practice.6 Community-based practice includes a broad range of services to address acute and chronic medical care, health promotion, disease and injury prevention, and rehabilitation.7 The American Occupational Therapy Association (AOTA) identifies six broad practice categories from which emerging practice allows occupational therapists to bring their skills and expertise to meet new and growing needs. Emerging practice is a multifaceted concept and encompasses diverse professional roles, a variety of contexts for the provision of services, as well as the development of innovative business models.8,9

However, in 2006, few occupational therapists responding to a workforce and salary survey conducted by AOTA10 identified community (1.6%) or emerging practice settings (other, 1.9%) as their primary work setting. Moreover, since 1997, the percentages of therapists in these settings decreased. While there are multiple challenges to the provision of services in new areas of practice, the lack of established reimbursement sources as well as the requirements associated with developing and marketing a new service are likely significant to this trend. Additionally, service delivery within these expanded areas of practice frequently requires the development of new models of practice to meet the needs of communities and populations.7,11 Innovative professional roles often encompass a blend of competencies and expertise that incorporate elements of entrepreneurship and leadership. As health professions evolve to meet the future needs for their services in communities and other settings, the educational preparation and ongoing support of their members will be essential to success in these new or expanded roles.

Occupational therapy educational programs endeavor to provide future occupational therapists with a foundation of essential skills for management, marketing, research, and leadership in preparation for roles such as consultants, administrators, entrepreneurs, and educators.12-20 In particular, the newly adopted standards for the master's degree and doctoral degree levels21,22 reflect the need to educate therapists to meet future challenges.

Additionally, educators and practicing therapists alike require professional development and support for building and teaching the knowledge and skills to engage in community-based or emerging practice roles.1 Multiple resources are available through professional membership organizations. For example, the AOTA Standards for Continuing Competence23 offer a template for ongoing professional development. These standards established five criteria by which occupational therapists address competencies, including requirements in each of the following areas: ( 1 ) the knowledge required for multiple roles; (2) the critical reasoning necessary for the multiple levels of decisions inherent in a variety of roles; (3) the interpersonal abilities of the practitioner for professional relationships with others; (4) the performance skills encompassing technical proficiencies, abilities, and aptitudes for practice; and (5) the ethical reasoning for responsible decision making.

Moyers and Hinojosa24 believe the standards require occupational therapy practitioners to "continually refine and update their knowledge, skills, and attitudes in those areas that make up the core of occupational therapy." Similarly, AOTA's Professional Development Tool25 provides a comprehensive plan to assist occupational therapy practitioners with assessing and organizing professional growth opportunities for continuing competency. Additionally, the AOTA Specialties Board26 and related panels developed competencies and certifications for the specialized practice areas of cognition, driver rehabilitation and community mobility, environmental modification, feeding and swallowing, and low vision. In addition to these resources, occupational therapists, currently engaged in developing and offering services in expanded and new practice environments, are a valuable source of information about the expectations and requirements of roles in these new professional contexts. Consequently, the purpose of this study was to identify and explore the professional competencies needed for emerging practice within the profession of occupational therapy.