Sunday, February 7, 2010

Setting the Standard for Therapy Assistant Utilization

One thing I have struggled with is trying to establish what really effective use of a therapy assistant should look like. There simply is no "gold standard" to compare how well a group of therapists is making use of therapy assistant or to compare one group with another group. But, I think there a number of principles we can start with.

First. Don't delegate anything to an assistant that would contravene your local practice legislation. For example, we would not have assistants determine the treatment plan for a patient.

Second. Do delegate EVERYTHING ELSE that that therapy assistant(s) is(are) competent to perform.

Third. If you cannot delegate because the assistant is not competent, then it should be a joint responsibility of management AND the therapist(s) to have a system in place to establish the competency of the assistant.

Finally, the above principles speak to the "ideal". The reality is that we can only aspire to "optimal" practice.

There will be two things that always being us back to this reality. One is that sometimes it simply makes sense for the PT to not delegate. For example, the patient may not consent to having an assistant perform certain tasks with them or the patient may wish to perform a routine task in order to develop rapport with the patient or to provide motivation for the patient to comply with a treatment plan.

Second, there will always be organizational restraints. The staffing ratio or staffing levels may make it impossible for the PT to delegate in some circumstances. You cannot delegate if there is no one to delegate to.

But, I believe the above principles will lead to the best utilization of therapy assistants. In a neighboring jurisdiction, the OT College advises that OTs should should have good rationals for delegating, but should also have a good rational when they decide not to delegate. If we can track what the barriers are to making use of therapy assistants, we create an opportunity to address those barriers.


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