Competency in Occupational Therapy

Competency in Occupational Therapy

Occupational therapy is an essential practice in ensuring positivity from individuals who experience different types of illnesses that result in the limitation of their level of involvement in their normal daily activities. It primarily ensures these individuals regain their ability to perform their activities; therefore enhance their quality of life. There are several causes of ill-health that results in the limitation of an individual’s involvement in their routine activities (Muhlenhaupt, de Sam Lazaro, Fabrizi, Schefkind, & Owens, 2019). Some of these include accidents and diseases that interfere with the normal functioning of an individual’s nervous system, thereby affecting the coordination of the different systems within their bodies. Through all these, competency in occupational therapy is essential in ensuring effective assessment and suggestion of viable recommendations that can help individuals effectively undertake their routine duties. This study will utilize Amir’s case in discerning the essence of competency in OT practice.

Amir was diagnosed with R hemorrhage CVA in which he was treated through the insertion of a coil and a left frontal external ventricular drain (EVD). The occupational therapy assessment report reveals that his response to self-care is fair since he could shower with moderate assistance and could moderately carry out his dressing exercise. The report revealed that Amir could put in his pants and shirts on his own. However, he could not fasten his buttons and zips. Similarly, Amir could also take his meals independently using his right arm with a little assistance in regards to set up and cutting the food. The report further reveals that Amir can sometimes get drowsy but is aware of his age, date, day, and month. In regards to the upper limb movement, Amir’s left shoulder reveals mild subluxation. Additionally, Amir has no active movement in his left upper limb and uses collar and cuff sling whenever he needs to move. However, his upper limb functionality report was not completed due to Amir becoming drowsy.

The recommendation provided includes continuing practicing showering and the use of long-handled sponge reacher to enhance his self-care. He is also to use a manual wheelchair and attend rehab physio sessions to help him in mobility and transfer. In regards to the effective functioning of his upper limb Amir is to use electrical stimulation that can be useful in managing the subluxation of shoulder muscles. He is also to participate in active assisted exercise. Additionally, Amir should also visit a physiotherapist to help in managing his psychosocial challenges.

Research questions and goals

Competency is an essential concept in ensuring the provision of quality services. Through this, individual professionals including occupational therapists (OTs) must ensure they possess the required skills and knowledge as well as the ability to need for quality and enhanced services. Through this, the study will concentrate on exploring the following questions that will also inform its goals

• What are the different stages involved in occupational therapy
• What are the different elements involved in occupation therapy competency
• What are the effective strategies used in enhancing competency levels among OTs
• What are the existing gaps in occupational therapy competency literature that need to be bridged?

Literature review

Sarsak (2018), performed research to present an overview of occupational therapy in psychosocial disorder. The study conducted a content analysis process from materials available in online databases like MEDLINE, PsychINFO, Global Health, and OVID as well as Pub Med. The key words utilized in identifying relevant materials from these sites include occupational therapy framework, psychosocial disorder, and occupational therapy. Through this, the study identified 8 stages to be involved in the occupational therapy process. These stages include referral screening, evaluation, intervention planning, intervention implementation, intervention review, transitional planning, and discontinuation of service respectively. There are several activities involved in each stage, which are also aligned with the characteristic of an individual patient.

Muhlenhaupt, de Sam Lazaro, Fabrizi, Schefkind, & Owens (2019), conducted a study to establish the core competencies used in enhancing OT in an early childhood setting. The study utilized content analysis in collecting the relevant data used. The results revealed four core competency areas, which include coordination and collaboration, family-centered practice, evidence-based interventions, and professionalism. The study concluded that proper observation of ethical standards would ensure the efficient and effective provision of quality OT services. These sentiments were also confirmed by VanderKaay, Jung, Letts & Moll (2019). VanderKaay eta al. (2019), performed research to underline the importance of competency in ethical decision making among occupational therapies. The study utilized purposive sampling to identify 18 participants who took part in an in-depth interview. The results revealed that there exists a lack of appropriate systems and structures that promote the proper observance of ethical principles among OTs.

Winstead (2018), performed a study to discern the different strategies community-based occupational therapists utilize to discharge their duties and enhance the quality of life individuals live. The study utilized an electronic survey in collecting data among members of the American occupational therapists association with experience in community-based occupational therapy. A total of 81 OTs participated in the study.  The study identified occupational therapy to be the beneficial use of routine activities in enhancing or enabling an individual’s level of participation in roles, activities, and routines in their homes, workplaces, school, and other social settings. Similarly, Winstead (2018), identified competency as the measures and indicators that define explicit areas of skills, knowledge, and ability in relation to an individual’s profession. The results revealed that self-directed learning, workplace education, and advancing education are the three most effective strategies utilized in enhancing individual OTs’ competency levels. Other strategies used in enhancing competency level among OTs are the feedback and mentoring as well as formal OT education. The study concluded that the availability of appropriate systems and structures is essential in enhancing the competency levels among individual OTs. Bowyer, Moore, Tiongco, Tkach & Thom (2017), also had the same observation in a study that utilized content analysis in the generation of data.

These five strategies are essential in developing and enhancing competency levels among occupational therapists. However, though the study observed that self-directed learning is more effective than feedback and mentoring, Myers, DeMaria & Pomeranz, (2019), asserted that feedback and mentoring are quite effective in enhancing individual OTs competency levels than self-directed earning. The reason behind this is that self-directed learning entails a self-adjustment to the best practice without proper follow up from an independent party. On the other hand, feedback and monitoring strategy allows for a review of specific areas that an individual occupational therapist should improve on to enhance their competency level. Further, Myers, DeMaria & Pomeranz, (2019), also concurred with Winstead (2018), finding that workplace training and advancement in education are some of the most effective strategies in enhancing and developing occupation therapy competency.

From all these, it is clear several studies have been conducted in regards to the various elements involved in occupational therapy competency. Several competency areas have also been identified. Though the studies conducted in this area seem sufficient there is one key competency area that has not been adequately covered; the cultural competency aspect. DeIuliis (2017), observed that service delivery in the contemporary world has evolved over time and currently there is the need for incorporation of the different cultural aspects in service provision to ensure a well-enhanced quality service. The inadequacy in regards to cultural competency in occupational therapy may be as a result of the data technique utilized by the majority of the studies conducted in this field. A good number of studies use content analysis, which is ineffective in relation to the identification of emerging issues.

Results

Table 1. The occupational therapy process

There are four primary elements involved in OT competency; these include collaboration and co-ordination, family-centered practice, evidence-based intervention, and professionalism and ethics (Muhlenhaupt et al., 2019). On the same note, there are different strategies that are utilized by OTs in enhancing their competency levels. These include formal OT education, self-directed learning, feedback and mentoring, workplace training, and advancement in education. Further, the concept of cultural competency has not been adequately explored in occupational therapy studies. As identified by DeIuliis (2017), the Incorporation of cultural diversity in OT practice is essential in ensuring enhancing the quality of OT services.

Discussion

In consideration of Amir’s case, the 8-steps occupational therapy process was duly observed. The observation of the process can be seen under different instances as first in the screening process where the OTs review his file and identifies his condition and the treatment that he has undergone. Similarly, the assessment process also reveals Amir’s response to different activities like self-care and psychosocial responses. Further, the report refers Amir to different facilities to continue his recovery including a rehab center. The OT assessment report reveals that the OT professional services Amir was quite collaborative and effectively co-ordinated the different treatment that Amir needed to undergo. Similarly, the service was family-centered considering that Amir could not fluently speak English together with his wife in which an interpreter was deployed.

Further, the services included evidence-based interventions, which included a range of movement exercises and active-assisted exercise. Similarly, a high degree of professionalism and ethics was also exhibited by the OT who took care of Amir. In this scenario, there was a need for incorporating cultural competency in assessing the quality of service Amir received. Amir is a south Sudanese who is not fluent in English. Similarly, he must have had some demands in regard to his culture that were not accounted for during the operation and his recovery process. Cultural diversity is a concept that needs to be incorporated in OT’s systems and procedures and as a core competency in OT.

Conclusion

Occupational therapy has evolved over time in which new concepts and procedures are being introduced to enhance the effectiveness of the practice. Maintaining quality OT services through observing the different competency elements like effective collaboration and co-ordination, family-centered service, professionalism, and ethics, as well as an evidence-based intervention is essential in providing quality occupational therapy services. Though not included among these four competency measures, cultural competency is necessary among OTs. The nature and scope of OT entail service provision to individuals with different backgrounds. Diversity not only exists along ethnicity and racial lines but also along religious, education, and personality lines. Through this, OT professionals need to develop their level of understanding involving the different views and perceptions among individuals with different backgrounds. Similarly, cultural competency is essential in overcoming the different challenges presented by these diversities. For instance, in Amir’s case, it is evident that there was a language barrier that hindered effective communication. OT professionals should ensure they incorporate cultural diversity in their systems and procedures to enhance the quality of services they render.

References

Bowyer, P., Moore, C., Tiongco, C., Tkach, M.,& Thom, C. (2017).Perspectives of occupational therapists on the challenges of early intervention practice: A pilot study. Journal of Occupational Therapy, Schools, & Early Intervention, 10, 18–26.https://doi.org/10.1080/19411243.2016.1257966

DeIuliis, E. (2017). Professionalism across occupational therapy practice. Thorofare, NJ: Slack.Early Childhood Personnel Center. (2017). Cross-disciplinary personnel competencies alignment. Retrieved from https://ecpcta.org/cross-disciplinary-alignmen

Muhlenhaupt, M., de Sam Lazaro, S. L., Fabrizi, S., Schefkind, S., & Owens, A. (2019). Interprofessional Core Competencies to Enhance Occupational Therapy Services in Early Childhood Settings. OT Practice, 24(3).

Myers, C. T., DeMaria, S., & Pomeranz, J. L. (2019). Building Consensus for Evidence-Based Practice Competencies for Occupational Therapists in the United States. Annals of International Occupational Therapy.

Sarsak, Hassan. (2018). The Occupational Therapy Process in Psychosocial Disorders: An Overview.

VanderKaay, S., Jung, B., Letts, L., & Moll, S. E. (2019). Continuing competency in ethical decision making: An interpretive description of occupational therapists’ perspectives. Canadian Journal of Occupational Therapy, 86(3), 209-219.

Winstead, S. (2018). Competency Development in Community‐Based Occupational Therapy. American Journal of Occupational Therapy, 72(4_Supplement_1), 7211510208p1-7211510208p1.