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Comparison of three program planning variables in continuing education in occupational therapy in British.. 1982

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COMPARISON OF THREE PROGRAM PLANNING VARIABLES IN CONTINUING EDUCATION IN OCCUPATIONAL THERAPY IN BRITISH COLUMBIA by LAURA M. HARVEY B.Sc.O.T., The University of Alberta, 1978 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS in THE FACULTY OF GRADUATE STUDIES (Department of Adult Education) We accept t h i s thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA May 19 82 (c) Laura M. Harvey, 19 82 In p r e s e n t i n g t h i s t h e s i s i n p a r t i a l f u l f i l m e n t of the requirements f o r an advanced degree at the U n i v e r s i t y of B r i t i s h Columbia, I agree t h a t the L i b r a r y s h a l l make i t f r e e l y a v a i l a b l e f o r r e f e r e n c e and study. I f u r t h e r agree t h a t p e r m i s s i o n f o r e x t e n s i v e copying of t h i s t h e s i s f o r s c h o l a r l y purposes may be granted by the head of my department or by h i s o r her r e p r e s e n t a t i v e s . I t i s understood t h a t c o p y i n g or p u b l i c a t i o n of t h i s t h e s i s f o r f i n a n c i a l g a i n s h a l l not be allowed without my w r i t t e n p e r m i s s i o n . Department of The U n i v e r s i t y of B r i t i s h Columbia 2075 Wesbrook P l a c e Vancouver, Canada V6T 1W5 DE-6 (2/79) ABSTRACT The purpose of t h i s investigation was to study variables important to the design of e f f e c t i v e continuing education programs for c l i n i c a l occupational therapists. The relationships between therapists' professional role and geographic location and three program planning variables were examined. The selected variables were: learning needs, barriers to p a r t i c i p a t i o n , and preferred delivery systems. A secondary purpose was to gather s p e c i f i c information upon which to base continuing education opportunities for therapists i n B r i t i s h Columbia. The sample for t h i s descriptive study was a l l members of the B r i t i s h Columbia Society of Occupational Therapists. An instrument was developed which examined the three program planning variables and a number of respondent c h a r a c t e r i s t i c s . The learning needs section was based on the assessment of the gap between existing and desired l e v e l of expertise on 30, competency statements. These competencies focused on three s k i l l areas frequently used by c l i n i c a l therapists: evaluation, therapeutic procedures, and the use of therapeutic equipment and materials. The two categories of barriers to p a r t i c i p a t i o n studied were s i t u a t i o n a l (those a r i s i n g from one's s i t u a t i o n at a given point i n time) and i n s t i t u t i o n a l (those planning practices and proce- dures which prevent p a r t i c i p a t i o n ) . In r e l a t i o n to delivery system, a comparison was made between selected d i r e c t and distance systems. i i i The rank-ordering of learning needs revealed evaluation as the competency area i n which the greatest need existed, p a r t i c u - l a r l y evaluation of perceptual-motor, cognitive and sensory function. Vocational assessment and treatment was also reported as a p r i o r i t y f o r planners when the high learning need and lack of t r a i n i n g opportunities were both considered. The findings indicated s i t u a t i o n a l b a r r i e r s to p a r t i c i p a t i o n were most f r e - quently encountered by the respondents with family r e s p o n s i b i l i t y and lack of time receiving the highest ranking. The overwhelming preference of delivery system was the workshop; respondents indicated minimal interest i n distance delivery systems. Few s i g n i f i c a n t differences were found between the percep- tions of c l i n i c a l and supervisory therapists or between urban and r u r a l therapists i n r e l a t i o n to the planning variables studied. Of the seven hypotheses studied, only the one suggesting differences in b a r r i e r s to p a r t i c i p a t i o n between urban and r u r a l therapists was supported at the l e v e l of significance adopted for t h i s study. ' The major implication of t h i s study i s the u t i l i t y of super- v i s o r s as a source of information f o r planning programs fo r c l i n i c a l therapists. The need f o r developing new assessment tools was also suggested by the findings of the study. The continued use of workshops as a major delivery system, regardless of geographic location of the therapist, was supported. Consid- ering the l i m i t e d resources avai l a b l e , planners should emphasize increasing the numbers of participants and whenever possible, the introduction of innovative programs. i v TABLE OF CONTENTS Page ABSTRACT i i LIST OF TABLES v i i ACKNOWLEDGEMENTS v i i i CHAPTER I INTRODUCTION AND PROBLEM DEFINITION 1 Professional Role and Continuing Education 2 Learning Needs 3 Barriers to P a r t i c i p a t i o n 6 Delivery Systems 8 Geographic Location and Continuing Education 9 Problem Summary 10 Significance of the Study 11 Research Questions 15 II RELATED LITERATURE 17 Introduction 17 Continuing Education i n Occupational Therapy 18 Professional Role and Continuing Education 2 0 Geographic Location and Continuing Education 24 Learning Needs 28 Needs Assessment 31 Barriers to P a r t i c i p a t i o n 36 Delivery Systems 41 Direct Delivery Systems 43 Distance Delivery Systems 44 Systems i n Continuing Education 46 Summary of Related Literature 51. V CHAPTER I I I METHOD 53 Setting of Study 53 Design 54 Hypotheses 54 Sample 54 Data C o l l e c t i o n 59 Instrumentation 59 Section I 60 Section II 62 Section III 63 P i l o t Test of Instrument 67 Procedures 6 8 Data Analysis 69 IV RESULTS 71 Response Rate 71 Characteristics of Respondents 72 Professional Role 73 Staff Size 75 Years of Employment 7 7 Geographic Location 78 Opportunity for Professional Contacts 81 Learning Needs 81 Relevance of Competencies 87 A v a i l a b i l i t y of Training Opportunities 91 Barriers to P a r t i c i p a t i o n 9 5 Delivery Systems 98 Tests of Hypotheses 102 Summary of Results 106 V DISCUSSION AND CONCLUSIONS 108 Professional Role and Continuing Education 109 Learning Needs 110 Barriers to P a r t i c i p a t i o n 114 Delivery Systems 115 Geographic Location and Continuing Education 118 Learning Needs 119 Barriers to P a r t i c i p a t i o n 122 Delivery Systems 123 v i Assessment Tool 125 Limitations of Research Design 128 Implications 129 Recommendations for Further Study 134 REFERENCES 137 REFERENCE NOTES 144 APPENDICES 145 Appendix A - Questionnaire 145 Appendix B - Letters of Transmittal 150 Appendix C - Letter of Support 153 v i i 80 LIST OF TABLES TABLE Page 1 D i s t r i b u t i o n of Occupational Therapists by Job T i t l e 74 2 Number of Occupational Therapists Under Respondent's Direction 76 3 D i s t r i b u t i o n of Occupational Therapists by Geographic Location 79 4 D i s t r i b u t i o n of Therapists' Professional Role by Geographic Location 5 Number of Opportunities f o r Professional Contact with Other Occupational Therapists 83 6 Total Need Estimate by Professional Role 84 7 Total Need Estimate by Geographic Location 85 8 Relevance of Competencies by Professional Role 88 9 Relevance of Competencies by Geographic Location 8 9 10 Perceived A v a i l a b i l i t y of Training by Professional Role 92 11 Perceived A v a i l a b i l i t y of Training by Geographic Location 9 3 12 Ranking Perceived Barriers to P a r t i c i p a t i o n by Professional Role 13 Ranking Perceived Barriers to P a r t i c i p a t i o n by Geographic Location 97 14 Ranking Preferred Delivery Systems by Professional Role 100 15 Ranking Preferred Delivery Systems by Geographic Location 101 96 ACKNOWLEDGEMENTS v i i i I wish to express my sincere appreciation to a "number of people whose contributions made t h i s study possible. In p a r t i c u l a r , to my committee members, Dr. T. Sork and Dr. D. Fi e l d i n g without whose learned counsel and patience, progress would not have been possible. To Dr. Margaret Moreau for her s t a t i s t i c a l expertise and Saturday mornings, I am indebted. For t h e i r u n f a i l i n g support and understanding i n the face of numerous c r i s e s , I thank l a famille Martz. F i n a l l y , I wish to acknowledge my brother, Gordon, whose scholarly example inspired me to take on thi s task. 1 CHAPTER ONE INTRODUCTION AND PROBLEM DEFINITION The ultimate goal of continuing education for occupational therapists i s to maximize the well-being of those for whom the therapist i s professionally responsible. As a p r i n c i p l e means of knowledge dissemination, continuing education helps professionals maintain and increase their competence in the rapidly changing f i e l d of health care. Unless an education system i s available which builds upon or modifies the previous experience of the therapist, knowledge and s k i l l s may soon become outdated. In spite of the current acknowledgement of the importance of continuing professional education by occupational therapists and their employers, there exist a number of problems in the provision of these educational opportunities. By far the greatest problem is that often program planning i s carried out by an individual as a r e s p o n s i b i l i t y secondary to another role. Common situations include the c l i n i c i a n who heads the continuing education committee of the l o c a l professional organization on a voluntary basis or the faculty member who devotes one day per week to planning continuing education ( B r i n t n e l l , Note 1 ) . It i s recognized that professionals who have th i s r e s p o n s i b i l i t y to design and conduct learning opportunities possess varied backgrounds, the majority having minimal or no tr a i n i n g in adult 2 education or program p l a n n i n g (Dowling, 1969). Th e r e f o r e , although p a r t i c i p a t i o n of t h e r a p i s t s i s s t r o n g l y encouraged, the r e s u l t i s of t e n a low p r i o r i t y given to the systematic p l a n n i n g of programs f o r which attendence i s sought. M a d i l l (1979) summarizes the d i f f i c u l t i e s f a c i n g o c c u p a t i o n a l t h e r a p i s t s i n the f i e l d of c o n t i n u i n g education. She s t a t e s the lack of long range planning and the lack of f l e x i b i l i t y i n d e l i v e r y systems are among the s i g n i f i c a n t problems to be confronted at present. She s t r e s s e s the ga t h e r i n g of b a s e l i n e i n f o r m a t i o n about d i f f e r e n t groups of t h e r a p i s t s and the d i s t r i b u t i o n of in f o r m a t i o n regarding t h e i r needs to planners as one method of p r a c t i c a l l y approaching problems i n c o n t i n u i n g e d u c a t i o n . Therefore, the primary purpose of t h i s study was to examine three v a r i a b l e s of the program planning process r e l e v a n t to the design of c o n t i n u i n g education o p p o r t u n i t i e s f o r c l i n i c a l o c c u p a t i o n a l t h e r a p i s t s . The s e l e c t e d v a r i a b l e s were l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n , and p r e f e r r e d d e l i v e r y systems. As w e l l , d i f f e r e n c e s in t h e r a p i s t s p e r c e p t i o n s of c o n t i n u i n g education as a f u n c t i o n of p r o f e s s i o n a l r o l e and geographic l o c a t i o n were s t u d i e d f o r t h e i r program plan n i n g i m p l i c a t i o n s . In a d d i t i o n , a secondary purpose of the study was to generate s p e c i f i c i n f o r m a t i o n upon which to base programs f o r t h e r a p i s t s i n B r i t i s h Columbia. P r o f e s s i o n a l Role and Continuing Education One of the major problems that c o n f r o n t s the program 3 planner is deciding upon which information to base planning decisions. Although i t i s an i m p l i c i t assumption in the majority of planning models that the potential participants are the primary source of planning information, information gathered from a number of p r a c t i t i o n e r s is often c o n f l i c t i n g in nature and thus of l i t t l e p r a c t i c a l help to the planner. One alternative commonly used in occupational therapy in order to save both time and money is to s o l i c i t from supervisory therapists information about the c l i n i c i a n s they supervise. The problem of determining which source of information to base programs on has been addressed in the f i e l d of adult education (Monette, 1977; G r i f f i t h , 1978) but has received l i t t l e attention in the area of health care. This study attempted to determine i f s i m i l a r i t y in perceptions of c l i n i c a l therapists' continuing education needs and preferences were held by c l i n i c i a n s and supervisors. Learning Needs Need has been defined by Bradshaw (1974) as the gap between an existing l e v e l of s k i l l or knowledge and a desired one. He distinguishes between f e l t needs, a subjective assessment of wants or desires, and normative needs, which are based on the objective evaluation of an expert. One program planning area in which professional role contributes to differences in perception i s learning needs. Differences in perception of c l i n i c i a n s ' learning needs in continuing education held by c l i n i c i a n s and their supervisors is the c o n f l i c t most frequently c i t e d in the health care l i t e r a t u r e . Chatham ('1979) suggests that 4 d i s c r e p a n c i e s i n p e r c e p t i o n of need e x i s t between c l i n i c i a n s and s u p e r v i s o r s i n f i v e a l l i e d h e a l t h f i e l d s while Smallegen (1981) acknowledges d i f f e r e n c e s between these two groups w i t h i n the area of n u r s i n g . Needs assessment i s often d e s c r i b e d as the f i r s t and perhaps most important step i n program plan n i n g models. The use of needs assessment i s based on the idea that i d e n t i f i c a t i o n of the p o t e n t i a l p a r t i c i p a n t ' s l e a r n i n g needs i s a necessary step in p l a n n i n g r e l e v a n t programs. When assessment i s based on s e l f - r e p o r t , i t i s d e s c r i b e d as a f e l t need assessment. An u n d e r l y i n g assumption i s that p a r t i c i p a t i o n i s i n f l u e n c e d by the i n d i v i d u a l ' s p e r c e p t i o n of t h e i r f e l t need f o r l e a r n i n g s p e c i f i c s k i l l s or knowledge. Acco r d i n g to Knowles (1970) and Houle (1972) the p o t e n t i a l p a r t i c i p a n t i s more l i k e l y to attend those a c t i v i t i e s that appear' r e l a t e d to t h e i r p e r s o n a l needs and i n t e r e s t s . In the case of p r o v i d i n g c o n t i n u i n g education f o r c l i n i c a l t h e r a p i s t s , the l o g i c a l assumption would be that the c l i n i c a l t h e r a p i s t s themselves would be the best source of r e l e v a n t i n f o r m a t i o n on l e a r n i n g needs. Relevancy, however, may be i n f l u e n c e d by the f a c t that few i n d i v i d u a l s are capable of i d e n t i f y i n g t h e i r own l e a r n i n g need. Atwood and E l l i s (1971) and Knox (1980) contend that f e l t needs are not the most v a l i d source of plan n i n g i n f o r m a t i o n . They suggest that i n d i v i d u a l s may be unable to evaluate t h e i r present l e v e l of knowledge or s k i l l or may be unaware of the standard l e v e l f o r comparison. In a d d i t i o n , the i n t e r e s t i n v e n t o r i e s that most o f t e n represent f e l t need assessments r a r e l y assess l e a r n i n g need as d e f i n e d . Nakamoto (1973) s t a t e s that because of 5 t h i s i n a b i l i t y of i n d i v i d u a l s to determine t h e i r own needs, the program planner should consider o b t a i n i n g a d d i t i o n a l i n f o r m a t i o n from other sources. T h i s study focused on one a l t e r n a t i v e to the assessment of f e l t need which i s the i d e n t i f i c a t i o n of normative l e a r n i n g needs. Normative need was d e f i n e d as the s u p e r v i s o r y t h e r a p i s t ' s p e r c e p t i o n of c l i n i c a l t h e r a p i s t s ' needs i n c o n t i n u i n g e d u c a t i o n . T h i s was based on the r a t i o n a l e that s u p e r v i s o r s , by v i r t u e of t h e i r r o l e as leaders of c l i n i c a l t h e r a p i s t s are able to provide some degree of o b j e c t i v i t y in the assessment of l e a r n i n g need. In order to reach a s u p e r v i s o r y p o s i t i o n i n the f i e l d of o c c u p a t i o n a l therapy, the t h e r a p i s t t y p i c a l l y has accumulated a number of years p r a c t i c e , o f t e n i n a v a r i e t y of s e t t i n g s , which p r o v i d e s a more o b j e c t i v e b a s i s f o r assessment than does that of the c l i n i c a l t h e r a p i s t whose a b i l i t y to c o n s i d e r needs may be l i m i t e d by i n e x p e r i e n c e . Assessment of f e l t need, d e s p i t e i t s frequency of use as a form of needs assessment, may not provide the most v a l i d source of i n f o r m a t i o n . The v a r i a b l e that was proposed i n t h i s study as a f f e c t i n g the d i f f e r e n c e between a normative l e a r n i n g assessment and a self-assessment i s the t h e r a p i s t ' s years of' experience i n o c c u p a t i o n a l therapy. Houle (1980) i d e n t i f i e s a number of f a c t o r s which i n f l u e n c e p e r c e p t i o n of need i n c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n , i n c l u d i n g e d u c a t i o n a l background and work s e t t i n g . He s t a t e s , however, t h a t years of p r o f e s s i o n a l experience i s a major i n f l u e n c e on p e r c e p t i o n of l e a r n i n g needs. In the case of t h e r a p i s t s , i t was suggested that the l e n g t h of 6 time that the t h e r a p i s t had been p r a c t i s i n g would c o n t r i b u t e to d i f f e r e n c e s in p e r c e p t i o n h e l d by c l i n i c i a n s and s u p e r v i s o r s . The study attempted to determine whether s i g n i f i c a n t d i f f e r e n c e s e x i s t between c l i n i c a l t h e r a p i s t s ' p e r c e p t i o n of t h e i r l e a r n i n g needs ( f e l t needs) and s u p e r v i s i n g t h e r a p i s t s ' p e r c e p t i o n of c l i n i c i a n ' s l e a r n i n g needs (normative needs). In examining these d i f f e r e n c e s , i t was not intended to determine which p e r c e p t i o n s were b e t t e r p r e d i c t o r s of p a r t i c i p a t i o n , r a ther the o b j e c t i v e was to determine whether d i f f e r e n c e s between f e l t and normative need e x i s t and what i m p l i c a t i o n s t h i s may have f o r the p r a c t i s e of program planning i n c o n t i n u i n g education i n o c c u p a t i o n a l therapy. B a r r i e r s to P a r t i c i p a t i o n Whether d i f f e r e n c e s i n p e r c e p t i o n s e x i s t i n terms of b a r r i e r s to p a r t i c i p a t i o n i n c o n t i n u i n g education i s another q u e s t i o n which was addressed. Although t h i s f a c t o r may not be c o n s i d e r e d as e s s e n t i a l i n the program p l a n n i n g models, i d e n t i f y i n g the f a c t o r s which may prevent p a r t i c i p a t i o n p r o v i d e s some b a s i s upon which to modify the present type of program in order to f a c i l i t a t e p a r t i c i p a t i o n . B a r r i e r s to p a r t i c i p a t i o n can be c o n s i d e r e d as: s i t u a t i o n a l , those a r i s i n g from one's own s i t u a t i o n at a given p o i n t i n time; i n s t i t u t i o n a l , those program p l a n n i n g p r a c t i s e s and procedures which discouragethe i n d i v i d u a l from p a r t i c i p a t i n g i n the program; or d i s p o s i t i o n a l , those r e l a t e d to the a t t i t u d e s and s e l f - p e r c e p t i o n s about o n e s e l f as a p o t e n t i a l l e a r n e r (Cross, 1980). In terms of d i f f e r e n c e s i n p e r c e p t i o n of b a r r i e r s to 7 p a r t i c i p a t i o n the role of the therapist i s an important consideration. The therapist having reached a supervisory position in the f i e l d of occupational therapy would l i k e l y have developed a strong commitment to the notion of continuing education. This commitment would be based p a r t i a l l y on an increased personal orientation toward a career as jobs with increasingly more r e s p o n s i b i l i t y are undertaken and would be p a r t i a l l y due to the necessity of p a r t i c i p a t i n g in continuing education as a means of obtaining and maintaining such positions (White, 1975). Because of the p r i o r i t y given to continuing education, s i t u a t i o n a l b a r r i e r s , such as family r e s p o n s i b i l i t y and cost would l i k e l y be less s i g n i f i c a n t than the i n s t i t u t i o n a l barriers which are frequently beyond the control of the therapist. For many c l i n i c a l therapists, however, the length of time since their i n i t i a l training would be minimal and thus the necessity of continuing education may be l e s s . The employment patterns in occupational therapy support this notion that c l i n i c i a n s tend to have less than five years experience in the f i e l d and that therapists with more experience tend to be in supervisory positions (Maxwell, 1977). Dispositional barriers were not considered in this study because of the comparatively few instances that they were reported in studies similar to this one. It i s l i k e l y that the nature of these barriers i s such that i t i s s o c i a l l y unacceptable to report them, and thus they are only rarely indicated on surveys as reasons for non- p a r t i c i p a t i o n . 8 Delivery Systems An examination of the differences in preferred delivery systems for continuing education programs in r e l a t i o n to the role of the therapist i s based on the influence of years of experience on perception. Considering the idea that supervising therapists would have had more opportunity to p a r t i c i p a t e in continuing education and possibly a greater need to p a r t i c i p a t e , their exposure to the t r a d i t i o n a l delivery systems of continuing education would be greater. When asked to express a preference among delivery systems, supervisory therapists would be more l i k e l y to i d e n t i f y a system which was familiar to them. In occupational therapy the d i r e c t delivery system has been by far the most frequently used and thus i t could be expected that supervisory therapists would prefer t h i s system. C l i n i c i a n s , however, having fewer experiences and l i k e l y more access to new technological educational tools in their undergraduate education may prefer the distance systems to the t r a d i t i o n a l ones. In summary, this study examined differences in perceptions held by c l i n i c a l therapists and supervisory therapists in r e l a t i o n to learning needs, barriers to p a r t i c i p a t i o n , and preferred delivery systems in continuing education. These differences were viewed in terms of their implications for determining the program planner's source of information upon which programs are based. 9 Geographic L o c a t i o n and Continuing Education Another major problem f o r the planner of c o n t i n u i n g education programs i s the g e o g r a p h i c a l l y i s o l a t e d l e a r n e r . In the case of o c c u p a t i o n a l t h e r a p i s t s i n B r i t i s h Columbia, i s o l a t i o n i s a major concern (Dickson, Note 3 ) . For the t h e r a p i s t i n o u t l y i n g r e g i o n s , c o n t i n u i n g education has h i s t o r i c a l l y been made i n a c c e s s i b l e both in terms of seeking input from r u r a l t h e r a p i s t s i n p l a n n i n g and in t h e i r a b i l i t y to p a r t i c i p a t e . Although surveying r u r a l t h e r a p i s t s f o r planning i n f o r m a t i o n may not appear as problematic as f a c i l i t a t i n g p a r t i c i p a t i o n , the cost i n v o l v e d and the time l a g that i s o f t e n a s s o c i a t e d with such surveys have tended to lower t h e i r u t i l i t y . Because of f i n a n c i a l demands, programs are designed to meet the needs of as many i n d i v i d u a l s as p o s s i b l e and a l a r g e number of p a r t i c i p a n t s i s necessary i n order to meet program budgets. The p o r t i o n of the t h e r a p i s t p o p u l a t i o n that p r o v i d e s the m a j o r i t y of p a r t i c i p a n t s and thus f i n a n c i a l support i s the two l a r g e urban areas i n B r i t i s h Columbia, Vancouver and V i c t o r i a . O p p o r t u n i t i e s f o r c o n t i n u i n g education i n o c c u p a t i o n a l therapy at present are r e s t r i c t e d to those r e s i d i n g i n these two urban c e n t e r s or those who are able to commit time and f i n a n c e s to t r a v e l . I r o n i c a l l y , i t i s those same t h e r a p i s t s who are unable to p a r t i c i p a t e in c o n t i n u i n g education because of the lack of program a v a i l a b i l i t y i n t h e i r area or the f i n a n c i a l support to t r a v e l to l a r g e r c e n t e r s that are most in need. Without c o l l e a g u e c o n t a c t , the i n s e r v i c e programs common in l a r g e r i n s t i t u t i o n s , or the easy access to f o r m a l i z e d programs, the 10 o p p o r t u n i t y f o r r u r a l t h e r a p i s t s to update knowledge and s k i l l s i s l e s s than for urban t h e r a p i s t s . Although the i n f l u e n c e of geographic i s o l a t i o n on r u r a l l e a r n e r s has r e c e i v e d abundant a t t e n t i o n i n the d i s t a n c e education l i t e r a t u r e , r e s e a r c h i n the f i e l d of o c c u p a t i o n a l therapy has been minimal. This study considered the e f f e c t s of geographic l o c a t i o n on the t h e r a p i s t s ' p e r c e p t i o n s of program planning v a r i a b l e s . S p e c i f i c a l l y , the d i f f e r e n c e s between urban and r u r a l t h e r a p i s t s ' p e r c e p t i o n s were c o n s i d e r e d i n r e l a t i o n to three areas i n program p l a n n i n g : l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n , and p r e f e r r e d d e l i v e r y systems. The i m p l i c a t i o n s to the program planner in c o n t i n u i n g education i n c l u d e determining whether the r u r a l t h e r a p i s t s r e q u i r e d i f f e r e n t program content than do urban t h e r a p i s t s and whether as a subgroup of o c c u p a t i o n a l t h e r a p i s t s , they are i n g r e a t e r need of c o n t i n u i n g education programs than t h e i r urban c o u n t e r p a r t s . F i n a l l y , the question of using d i s t a n c e types of d e l i v e r y systems i n o c c u p a t i o n a l therapy was examined. Problem Summary This study attempted to address some of the problems of p r a c t i c e c o n f r o n t i n g the planners of c o n t i n u i n g education i n o c c u p a t i o n a l therapy. Because of the marginal r o l e that planners have i n the f i e l d of o c c u p a t i o n a l therapy, l i t t l e i n f o r m a t i o n has been documented and made a v a i l a b l e to a s s i s t the planner i n making d e c i s i o n s upon which to base programs.The source of such i n f o r m a t i o n was examined i n t h i s study through comparison of 11 p e r c e p t i o n s of c l i n i c a l t h e r a p i s t s ' l e a r n i n g needs and pre f e r e n c e s held by s u p e r v i s o r s and c l i n i c a l t h e r a p i s t s . A second problem s t u d i e d was the e f f e c t s of geographic i s o l a t i o n of o c c u p a t i o n a l t h e r a p i s t s on c o n t i n u i n g e d u c a t i o n . E x i s t i n g programs are oft e n i n a c c e s s i b l e to r u r a l t h e r a p i s t s because of the tendency f o r them to be l o c a t e d i n l a r g e m e t r o p o l i t a n c e n t e r s . T h i s study attempted to determine i f r u r a l t h e r a p i s t s were s u f f i c i e n t l y d i f f e r e n t from t h e i r urban c o l l e a g u e s to be co n s i d e r e d f o r s p e c i a l programming procedures. The i m p l i c a t i o n s of studying these problems l i e i n the generation o f - b a s e l i n e data on a number of i s s u e s b a s i c to o c c u p a t i o n a l therapy upon which s p e c i f i c p l a n n i n g d e c i s i o n s can be made f o r f u t u r e programs i n B r i t i s h Columbia. S i g n i f i c a n c e of the Study Fear of p r o f e s s i o n a l obsolescence i s c i t e d by many as the major f o r c e behind the p r o l i f e r a t i o n of c o n t i n u i n g education courses that has occur r e d i n the past decade (Hightower, 1973; Hoffman, 1979a; Houle, 1980; Koonz, 1978). Obsolescence, or e r o s i o n of t e c h n i c a l knowledge w i t h i n the p r o f e s s i o n due to the d i m i n i s h i n g value of once proven methods, i s a major concern i n the f i e l d of o c c u p a t i o n a l therapy ( M a d i l l , 1979). The f a c t t h at the h a l f - l i f e of medical knowledge i s now estimated to be f i v e years a t t e s t s to the r e a l i t y of t h i s f e ar (Hoffman, 1979b). In t h i s c o n t e x t , h a l f - l i f e i s the amount of time that passes before an i n d i v i d u a l , because of new developments, techniques and knowledge, becomes roughly h a l f as competent to do the. job f o r 1 2 which they were t r a i n e d . The i m p l i c a t i o n of t h i s f o r o c c u p a t i o n a l t h e r a p i s t s l i e s in the n e c e s s i t y of updating t h e i r s k i l l s and knowledge on a continuous b a s i s i n order to p r a c t i s e in a competent manner. In response to the th r e a t of obsolescence, many h e a l t h care groups have chosen to make c o n t i n u i n g education mandatory i n order f o r p r a c t i t i o n e r s to r e t a i n t h e i r l i c e n c e . In many j u r i s d i c t i o n s i n North America, medicine, d e n t i s t r y , n u r s i n g , and pharmacy have introduced l e g i s l a t i o n that r e q u i r e s p r o f e s s i o n a l s to p a r t i c i p a t e i n a minimum number of hours a n n u a l l y in c e r t i f i e d c o n t i n u i n g education programs ( S t r o s s and Harlan, 1978). The i n f l u e n c e of mandatory p a r t i c i p a t i o n on the area of c o n t i n u i n g education i s d i r e c t . Although l e g i s l a t e d c o n t i n u i n g education i s yet to be int r o d u c e d i n the f i e l d of o c c u p a t i o n a l therapy, and t h e r e f o r e i s not a d i r e c t i n f l u e n c e on the growth of the f i e l d , a number of f o r c e s are c r e a t i n g an unprecedented demand f o r such opportun i t i es. Cooper (1973) s t a t e s that d i r e c t and i n d i r e c t changes i n the f i e l d of h e a l t h care r e s u l t from a l t e r a t i o n s i n the s o c i e t y that the p r o f e s s i o n s e r v e s . S o c i a l trends have t h e i r impact both on the h e a l t h p r o f e s s i o n a l s as a d i s t i n c t group w i t h i n s o c i e t y and the p o p u l a t i o n as a whole. For example, the in c r e a s e d m o b i l i t y of the p o p u l a t i o n i s a f a c t o r i n high employment turnover i n the h e a l t h care f i e l d which has i m p l i c a t i o n s f o r the frequency of o r i e n t a t i o n - r e l a t e d c o n t i n u i n g e d u c a t i o n . The s h i f t i n the age d i s t r i b u t i o n of the p o p u l a t i o n i s important to the content of programs. C o n s i d e r i n g that 12% of the p o p u l a t i o n w i l l be over the age of 65 years by the year 2001 ( M a r s h a l l , 1980), 13 g e r o n t o l o g i c a l i s s u e s are becoming more p r e v a l e n t . In a d d i t i o n t h i s s o c i a l trend has i m p l i c a t i o n s for the r e a c t i v a t i o n of t h e r a p i s t s who wish to re-enter the work f o r c e a f t e r a long absence. Matthews and Schumasters (1979) d e s c r i b e the s o c i e t a l r o l e of c o n t i n u i n g education by s t a t i n g that i n c r e a s i n g demands fo r more and b e t t e r h e a l t h care are r e s u l t i n g i n i n c r e a s i n g use of c o n t i n u i n g education to s a t i s f y p u b l i c p r e s s u r e . C o n t i n u i n g education then, i s n e c e s s i t a t e d by changes i n the d e l i v e r y of h e a l t h care which have been c r e a t e d by the p u b l i c ' s heightened awareness i n the f i e l d of h e a l t h . The c u r r e n t upsurge of programs d e a l i n g with the l e g a l aspects of p r o f e s s i o n a l p r a c t i s e in h e a l t h care i s an e x c e l l e n t i l l u s t r a t i o n of t h i s . Another f o r c e i n f l u e n c i n g c o n t i n u i n g education that i s a s s o c i a t e d with the i n c r e a s i n g p u b l i c involvement i s government i n t e r v e n t i o n . P a r t i a l l y due to p u b l i c lobby, new h e a l t h care programs and d e l i v e r y systems have been in t r o d u c e d in a l l areas of h e a l t h c a r e . T h i s has f a c i l i t a t e d d i v e r s i f i c a t i o n and expansion of the r o l e s of h e a l t h care workers which may n e c e s s i t a t e the p r a c t i t i o n e r ' s l e a r n i n g or r e l e a r n i n g s k i l l s and knowledge to f u l f i l l these r o l e s . The recent a t t e n t i o n to l e a r n i n g d i s a b i l i t i e s w i t h i n the school system, f o r example, has c r e a t e d a new r o l e f o r the t h e r a p i s t (Levangie, 1980; Punwar and Werdt, 1980). The change i n focus of government p o l i c y , q u i t e f r e q u e n t l y accompanied by f i n a n c i a l support, can i n c r e a s e the demand f o r c o n t i n u i n g education through changing manpower needs. In a d d i t i o n to the i n f l u e n c e of m u l t i p l e s e t t i n g s f o r p r a c t i s e , both c l i n i c a l and a d m i n i s t r a t i v e competencies are r e q u i r e d w i t h i n each s e t t i n g thereby p l a c i n g dual demands on the 1 4 c o n t i n u i n g education programs. Changing employment p a t t e r n s f o r women i s another s o c i a l i n f l u e n c e on the area of c o n t i n u i n g e d u c a t i o n . Trends such as i n c r e a s i n g i n c i d e n c e s of part-time employment, r e t u r n to work i n m i d - l i f e , and m u l t i p l e career changes are e s p e c i a l l y n o t i c e a b l e in the f i e l d of o c c u p a t i o n a l therapy where the m a j o r i t y of p r a c t i t i o n e r s are women. Degree completion and r e - e n t r y types of c o n t i n u i n g education o p p o r t u n i t i e s i n o c c u p a t i o n a l therapy are one product of t h i s t r e n d . Changes w i t h i n the h e a l t h care f i e l d i t s e l f are a l s o having an impact on c o n t i n u i n g education. T e c h n o l o g i c a l advancement and r e l a t e d medical developments have and w i l l continue to have a profound i n f l u e n c e on a b i . l i l t y of p r o f e s s i o n a l s to maintain competency. Innovations in procedures, techniques, r e s e a r c h , and equipment have rendered o b s o l e t e many d i a g n o s t i c and t h e r a p e u t i c p r a c t i s e s . In a d d i t i o n , there has been a n o t i c e a b l e s h i f t in the whole philosophy of h e a l t h care away from cure to p r e v e n t i o n , a s h i f t that has been a c u t e l y f e l t i n the f i e l d of o c c u p a t i o n a l therapy. Basic t r a i n i n g in o c c u p a t i o n a l therapy can no longer adequately prepare the t h e r a p i s t f o r a l l the r o l e s to be c a r r i e d out i n p r a c t i s e nor can i t keep the t h e r a p i s t updated. Woodside (1977) s t a t e s that the problem of advancement in the f i e l d of h e a l t h care has been exacerbated by the la c k of graduate programs i n which t h e r a p i s t s would have o p p o r t u n i t y to update t h e i r knowledge. As a r e s u l t of p r o f e s s i o n a l , s c i e n t i f i c , and t e c h n o l o g i c a l developments, the d e l i v e r y of h e a l t h care i s becoming i n c r e a s i n g l y complex, the r e s p o n s i b i l i t i e s of the h e a l t h care worker more d i v e r s i f i e d , and the need f o r c o n t i n u i n g 15 education more widespread. As i n many h e a l t h p r o f e s s i o n s , o c c u p a t i o n a l therapy i s i n a p e r i o d of major t r a n s i t i o n , one which a c c o r d i n g to Hoffman (1979a) i s to co n t i n u e . He suggests that the i n c r e a s i n g numbers of o l d e r p r o f e s s i o n a l s , the p r o p o r t i o n of female p r o f e s s i o n a l s , and the emphasis on r e - l i c e n s i n g w i l l c o n t r i b u t e to the changing nature of the h e a l t h care f i e l d i n the f u t u r e . Fear of t e c h n i c a l obsolescence, r a p i d s o c i a l change, and in c r e a s e d a c c o u n t a b i l i t y to the p u b l i c have placed p r o f e s s i o n a l competency i n q u e s t i o n . T h i s concern f o r competence among h e a l t h p r o f e s s i o n a l s i s observed i n a number of ways. Among p r a c t i t i o n e r s the concern i s of t e n r e f l e c t e d i n e f f o r t s to d e s c r i b e standards of care or e s t a b l i s h q u a l i t y assurance programs. Among educators, the concern i s represented by the development of new and the reform of e x i s t i n g c o n t i n u i n g education programs. Research Quest ions T h i s study was designed to i n v e s t i g a t e three program pl a n n i n g v a r i a b l e s i n c o n t i n u i n g e d u c a t i o n : l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n and p r e f e r r e d d e l i v e r y systems. These v a r i a b l e s were co n s i d e r e d i n r e l a t i o n to four subgroups of o c c u p a t i o n a l t h e r a p i s t s : c l i n i c a l t h e r a p i s t s , s u p e r v i s o r y t h e r a p i s t s , r u r a l c l i n i c a l t h e r a p i s t s , and urban c l i n i c a l t h e r a p i s t s . The study addressed the f o l l o w i n g r e s e a r c h q u e s t i o n s : 1) Do d i f f e r e n c e s in p e r c e p t i o n s of c l i n i c a l t h e r a p i s t s ' l e a r n i n g needs e x i s t between c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y 16 t h e r a p i s t s ? 2) Do c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s have d i f f e r e n t p e r c e p t i o n s of the b a r r i e r s — t o p a r t i c i p a t i o n experienced by c l i n i c a l t h e r a p i s t s ? S p e c i f i c a l l y , do s u p e r v i s o r y t h e r a p i s t s more often i d e n t i f y i n s t i t u t i o n a l b a r r i e r s to p a r t i c i p a t i o n than s i t u a t i o n a l ones? 3) Do c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s have d i f f e r e n t p e r c e p t i o n s of the d e l i v e r y systems p r e f e r r e d by c l i n i c a l t h e r a p i s t s ? S p e c i f i c a l l y , do s u p e r v i s o r y t h e r a p i s t s more o f t e n i d e n t i f y d i r e c t d e l i v e r y systems than d i s t a n c e ones while c l i n i c a l t h e r a p i s t s more o f t e n p r e f e r d i s t a n c e d e l i v e r y systems? 4) Do d i f f e r e n c e s in l e a r n i n g needs e x i s t between r u r a l and urban c l i n i c a l t h e r a p i s t s ? 5) Do r u r a l t h e r a p i s t s have a higher o v e r a l l need f o r c o n t i n u i n g education than do urban c l i n i c a l t h e r a p i s t s ? 6) Do r u r a l t h e r a p i s t s and urban t h e r a p i s t s have d i f f e r e n t p e r c e p t i o n s of b a r r i e r s to p a r t i c i p a t i o n i n c o n t i n u i n g education? S p e c i f i c a l l y , do r u r a l t h e r a p i s t s more o f t e n choose s i t u a t i o n a l b a r r i e r s to p a r t i c i p a t i o n than i n s t i t u t i o n a l while urban t h e r a p i s t s more o f t e n choose i n s t i t u t i o n a l b a r r i e r s ? 7) Do d i f f e r e n c e s in preference i n d e l i v e r y systems e x i s t between r u r a l t h e r a p i s t s and urban t h e r a p i s t s ? S p e c i f i c a l l y , do r u r a l t h e r a p i s t s more o f t e n choose d i s t a n c e d e l i v e r y systems than d i r e c t d e l i v e r y systems while urban t h e r a p i s t s more o f t e n choose d i r e c t systems? 17 CHAPTER TWO RELATED LITERATURE T h i s review of r e l a t e d l i t e r a t u r e provides an overview of the area being i n v e s t i g a t e d . I t summarizes the c u r r e n t s t a t u s of c o n t i n u i n g education in the f i e l d of o c c u p a t i o n a l therapy and i n other d i s c i p l i n e s in the h e a l t h s c i e n c e s when a p p r o p r i a t e . In a d d i t i o n i t pro v i d e s background on the three program planning v a r i a b l e s s t u d i e d , and on the hypothesized r e l a t i o n s h i p between these v a r i a b l e s and two c h a r a c t e r i s t i c s of the sample, p r o f e s s i o n a l r o l e and geographic l o c a t i o n . Introduct ion A comprehensive review of the l i t e r a t u r e r e v e a l s that although the need f o r c o n t i n u i n g education i n o c c u p a t i o n a l therapy i s w e l l documented, rese a r c h e f f o r t s i n the area have been minimal. The i n f o r m a t i o n that i s a v a i l a b l e t y p i c a l l y emphasizes the n e c e s s i t y of c o n t i n u i n g education or d e s c r i b e s s p e c i f i c programs that have been implemented. Smorynski and Panocha (1979) s t a t e that the small s i z e of many a l l i e d h e a l t h p r o f e s s i o n s and the d i v e r s e number of work s e t t i n g s in which they are employed l i m i t r e s e a r c h o p p o r t u n i t i e s i n c o n t i n u i n g e d u c a t i o n . These r e s t r i c t i o n s would appear to apply to the f i e l d of o c c u p a t i o n a l therapy. 18 A number of h e a l t h f i e l d s however, have a s u b s t a n t i a l amount of i n f o r m a t i o n a v a i l a b l e on c o n t i n u i n g education. Medicine, n u r s i n g , and pharmacy in p a r t i c u l a r are s u f f i c e n t l y s i m i l a r i n nature to o c c u p a t i o n a l therapy to allow the g e n e r a l i z a t i o n of research f i n d i n g s to o c c u p a t i o n a l therapy. T h i s review of r e l a t e d l i t e r a t u r e , then, i s based p r i m a r i l y upon documentation from other h e a l t h care f i e l d s . Houle (1980), however, c a u t i o n s the readers of the c o n t i n u i n g education l i t e r a t u r e that much of the m a t e r i a l i s d i f f i c u l t to s y n t h e s i z e . He s t a t e s that t h i s i s because the m a j o r i t y of i n v e s t i g a t i o n s are d e s c r i p t i v e in nature and because few s t u d i e s t e s t hypotheses or permit comparison. In a d d i t i o n , he d e s c r i b e s the data as being s p e c i f i c in time and l i m i t e d i n range. Acknowledging the l i m i t a t i o n s of t h i s body of knowledge, a review of the r e l a t e d l i t e r a t u r e on each of the major v a r i a b l e s in t h i s study w i l l be presented. C o n t i n u i n g Education i n O c c u p a t i o n a l Therapy Woodside (1977) i d e n t i f i e s c o n t i n u i n g education as a p r i o r i t y i n o c c u p a t i o n a l therapy. She emphasizes the importance of l i f e l o n g l e a r n i n g and the n o t i o n that at no p o i n t can t h e r a p i s t s c o n s i d e r themselves " f i n i s h e d products." M a d i l l (1979) summarizes the s t a t e of the a r t of c o n t i n u i n g education i n o c c u p a t i o n a l therapy i n her statement that beyond p u b l i c i z i n g programs, l i t t l e a t t e n t i o n has been p a i d to c o n t i n u i n g education i n e i t h e r the Canadian or American l i t e r a t u r e . Although she i d e n t i f i e s s e v e r a l areas that r e q u i r e 19 i n v e s t i g a t i o n and c h a l l e n g e s t h e r a p i s t s to i n i t i a t e r esearch on these t o p i c s , to date nothing f u r t h e r has been p u b l i s h e d i n the Canadian l i t e r a t u r e . Both of these w r i t e r s b u i l d a s o l i d case for the e x i s t e n c e of c o n t i n u i n g education programs, but beyond these statements of r a t i o n a l e , only a few s t u d i e s were found which surveyed t h e r a p i s t s i n an attempt to generate b a s e l i n e data on c o n t i n u i n g e d u c a t i o n . B i e r s and Murphy (1970) co n s i d e r e d c o n t i n u i n g education i n r e l a t i o n to both a c t i v e and i n a c t i v e t h e r a p i s t s . The c o n c l u s i o n reached by these r e s e a r c h e r s was that c o n t i n u i n g education i s important i n upgrading the q u a l i t y of p r o f e s s i o n a l performance but i s l e s s i n f l u e n c i a l i n i n c r e a s i n g the number of t h e r a p i s t s a c t i v e in the f i e l d by r e t r a i n i n g those t h e r a p i s t s who had been out of the work f o r c e f o r s e v e r a l years. McGregor (Note 5) gathered data on o c c u p a t i o n a l t h e r a p i s t s i n the p r o v i n c e of B r i t i s h Columbia. Her study examined the d i s t r i b u t i o n of t h e r a p i s t s by such f a c t o r s as job t i t l e , education and career g o a l s , and l o c a t i o n . A t o t a l of 22 v a r i a b l e s were c o n s i d e r e d i n r e l a t i o n to t h e i r i m p l i c a t i o n s f o r program plan n i n g in c o n t i n u i n g education. One of her major f i n d i n g s was that i n s e r v i c e education and p r o f e s s i o n a l j o u r n a l s were f r e q u e n t l y u t i l i z e d as c o n t i n u i n g education sources and that c o s t was a major b a r r i e r to p a r t i c i p a t i n g i n o p p o r t u n i t i e s that were a v a i l a b l e at that time. Her r e s u l t s suggest that t h e r a p i s t s a t t e n d at l e a s t one c o n t i n u i n g education program every two years and that the most h i g h l y favored methods were the short course and correspondence. When l e a r n i n g needs were c a t e g o r i z e d and rank ordered, drug r e l a t e d i n f o r m a t i o n and 20 p e r c e p t u a l and v o c a t i o n a l assessment were c o n s i d e r e d areas of highest l e a r n i n g need. Another source of i n f o r m a t i o n on c o n t i n u i n g education was the l i t e r a t u r e p u b l i s h e d by the p r o f e s s i o n a l o r g a n i z a t i o n s i n o c c u p a t i o n a l therapy. The Canadian A s s o c i a t i o n of Occupational T h e r a p i s t s and the American Oc c u p a t i o n a l Therapy A s s o c i a t i o n have both d e s c r i b e d c o n t i n u i n g education as a primary r e s p o n s i b i l i t y of the t h e r a p i s t and l i n k p a r t i c i p a t i o n to the maintainence of competency to p r a c t i c e . T h e i r p o l i c y statements o u t l i n e g o a l s , suggest methods of needs assessment, and d e l i v e r y systems but nothing beyond these general statements of support of c o n t i n u i n g p r o f e s s i o n a l education i s a v a i l a b l e . P r o f e s s i o n a l Role and Continuing Educat ion The p r o f e s s i o n a l d u t i e s that t h e r a p i s t s c a r r y out i n t h e i r p a r t i c u l a r work s e t t i n g s are so d i v e r s e i n nature that grouping t h e r a p i s t s according to t h e i r p r o f e s s i o n a l r o l e i s d i f f i c u l t . Because of the s t r u c t u r e d nature of the h e a l t h care system, two broad c a t e g o r i e s of r o l e d e s c r i p t i o n may be i d e n t i f i e d , c l i n i c a l t h e r a p i s t and s u p e r v i s i n g t h e r a p i s t . In h i s d e s c r i p t i o n of the work p l a c e s of p r o f e s s i o n a l s Houle (1980) s t a t e s that a l l i e d h e a l t h p r o f e s s i o n a l s are f r e q u e n t l y employed i n h i e r a r c h i c a l s e t t i n g s c h a r a c t e r i z e d by an ordered s t r u c t u r e of a u t h o r i t y . McGregor (Note 5) and L.angwell, Wilson, and Paine (1981) observed • that the m a j o r i t y of t h e r a p i s t s are employed in some type of h e a l t h care i n s t i t u t i o n and that a common p a t t e r n of r o l e i d e n t i f i c a t i o n e x i s t s . McGregor's data i n d i c a t e that i n 21 1975, 28% of t h e r a p i s t s surveyed were employed in p s y c h i a t r i c h o s p i t a l s , 24% i n r e h a b i l i t a t i o n c e n t e r s , 24% in general h o s p i t a l s , and 22% i n home care, extended c a r e , or s p e c i a l i t y u n i t s . A l l of these s e t t i n g s can be con s i d e r e d h i e r a r c h i c a l i n s t r u c t u r e . Within t h i s s t r u c t u r e , t h e r a p i s t s begin t h e i r p r o f e s s i o n a l c a r e e r as c l i n i c i a n s who's primary r e s p o n s i b i l i t y i s d i r e c t p a t i e n t c a r e . The c l i n i c a l t h e r a p i s t may perform a v a r i e t y of d u t i e s but i s not r e s p o n s i b l e f o r other p r o f e s s i o n a l s . The s u p e r v i s o r y t h e r a p i s t s ' r o l e i s c h a r a c t e r i z e d by a d e l e g a t i o n of d i r e c t p a t i e n t care i n order that they may c a r r y out supervisory/management f u n c t i o n s (Stan, Note 8). Within t h i s h i e r a r c h i c a l s e t t i n g the common p a t t e r n i s f o r a c l i n i c a l t h e r a p i s t to work i n that p o s i t i o n f o r approximately f i v e years and then to assume e i t h e r a s e n i o r t h e r a p i s t or su p e r v i s o r y p o s i t i o n . According to Stan, the s u p e r v i s o r y r o l e tends to r e f l e c t a number of years i n c l i n i c a l p r a c t i s e r a t h e r than a d d i t i o n a l education. Baum (1978) d e s c r i b e s the manager of oc c u p a t i o n a l therapy s e r v i c e s as having t r a n s f e r r e d the oc c u p a t i o n a l therapy treatment process to an a d m i n i s t r a t i v e s i t u a t i o n which allows t h e r a p i s t s to achieve the program o b j e c t i v e s . Because of t h e i r f a m i l i a r i t y and e x p e r t i s e i n the c l i n i c a l r o l e , t h e r a p i s t s are promoted to s u p e r v i s o r y p o s i t i o n s so that they can apply t h e i r experience to another set of problems. Based on the d i f f e r e n c e s i n the a c t i v i t i e s performed by c l i n i c a l and s u p e r v i s o r y t h e r a p i s t s , one would expect d i f f e r e n c e s i n p e r c e p t i o n s about c o n t i n u i n g education between the two groups (White, 1975). Although there has been no 22 r e s e a r c h i n the area of o c c u p a t i o n a l therapy, a number of s t u d i e s i n other h e a l t h care f i e l d s have documented t h i s and suggest that these d i f f e r e n c e s in p e r c e p t i o n may be a t t r i b u t e d to the length of time that the s u p e r v i s o r has been p r a c t i s i n g i n comparison to the c l i n i c i a n . Houle (1980) and Perry (1969) suggest that the number of changes .in c a r e e r l i n e i s a f u n c t i o n of the in c r e a s e d l e n g t h of time the i n d i v i d u a l i s i n v o l v e d i n the f i e l d and that t h i s i n f l u e n c e s one's p e r c e p t i o n s of c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n . C a s t l e and Story (1968) suggest that the age of a person i s r e l a t e d to t h e i r management or s u p e r v i s o r y r o l e s and that t h i s i n f l u e n c e s p e r c e p t i o n of c o n t i n u i n g e d u c a t i o n . T h e i r study suggests that d i f f e r e n c e s e x i s t between management and non- management groups in the h e a l t h care f i e l d . The most s i g n i f i c a n t d i f f e r e n c e s i n p e r c e p t i o n s occur i n the statement of pr e f e r e n c e s in program content and method of d e l i v e r y . The Canadian A s s o c i a t i o n of Occupa t i o n a l T h e r a p i s t s ' o f f i c i a l d e s c r i p t i o n of the f u n c t i o n s of c l i n i c a l and s u p e r v i s o r y t h e r a p i s t s support the notion of d i f f e r e n c e s i n p e r c e p t i o n between these groups. I t i s s t a t e d that although the s u p e r v i s o r should work with t h e i r c l i n i c a l experience as a base, t h e i r p e r s p e c t i v e should be broader than that of d i r e c t p a t i e n t care on a day to day b a s i s (Stan, Note 8). In a d d i t i o n , the s u p e r v i s o r y t h e r a p i s t ' s past experience i n a v a r i e t y of d i f f e r e n t work s e t t i n g s and a l l i e d h e a l t h d i s c i p l i n e s w i t h i n these s e t t i n g s i s d e s c r i b e d as e s s e n t i a l to the decision-making processes of a t h e r a p i s t in a s u p e r v i s o r y p o s i t i o n . There appears, then, to be a b a s i s f o r d i f f e r e n c e s i n 23 p e r c e p t i o n about needs and p r e f e r e n c e s i n c o n t i n u i n g education between c l i n i c i a n s and t h e i r s u p e r v i s o r s . Studies supporting these d i f f e r e n c e s as a f u n c t i o n of p r o f e s s i o n a l r o l e have been mainly c a r r i e d out in the f i e l d of n u r s i n g . T h i s i s l i k e l y a r e s u l t of the almost u n i v e r s a l e x i s t e n c e of "head" or s u p e r v i s o r y nurses and " s t a f f " or c l i n i c a l nurses. Chathan (1979) d e s c r i b e s a study where s i g n i f i c a n t d i f f e r e n c e s e x i s t between d i r e c t o r s of nurses and s t a f f nurses in the i d e n t i f i c a t i o n of l e a r n i n g needs. In the c o n c l u s i o n s of the study, the relevance of the f i n d i n g s f o r o b t a i n i n g program pl a n n i n g i n f o r m a t i o n i s acknowledged. In her survey on o b t a i n i n g and developing ideas f o r program o f f e r i n g s , Smallgren (1981 ) i d e n t i f i e s the e x i s t e n c e of two groups of nurses, the p r a c t i t i o n e r s and the experts who s u p e r v i s e these p r a c t i t i o n e r s . She s t a t e s that because d i f f e r e n c e s in p e r c e p t i o n e x i s t between these groups, d i f f e r e n t methods of pl a n n i n g must be u t i l i z e d depending upon from which group the p l a n n i n g i n f o r m a t i o n i s sought. Staub (1967) q u e r i e s whether persons in l e a d e r s h i p r o l e s in the nursing f i e l d may have d i f f e r e n t p e r c e p t i o n s about the e d u c a t i o n a l process than non-leaders. She i d e n t i f i e s years of experience and years of education as major d i f f e r e n c e s between these groups. These d i f f e r e n c e s i n p e r c e p t i o n s are a l s o the b a s i s of White's (1975) study on d i f f e r e n c e s i n c o n t i n u i n g education programs f o r c l i n i c a n s and s u p e r v i s o r s i n the h e a l t h care f i e l d . He s t a t e s that d i f f e r e n c e s i n need assessment, t e a c h i n g method, and c u r r i c u l u m c o n s t r u c t i o n should be c o n s i d e r e d s e p a r a t e l y f o r each group. He a l s o q u e s t i o n s the e f f e c t of having one of these 24 groups making decisons about the c o n t i n u i n g education needs and p r e f e r e n c e s of the other but comes to no c o n c l u s i o n about how planners should address these d i f f e r e n c e s in p e r c e p t i o n Geographic Locat ion and Cont i n u i n g Educat ion Although the problem of p r o v i d i n g l e a r n i n g o p p o r t u n i t i e s for i n d i v i d u a l s who are g e o g r a p h i c a l l y i s o l a t e d has been addressed by the f i e l d of a d u l t education s i n c e i t s development, i t i s only r e c e n t l y that h e a l t h p r o f e s s i o n a l s have considered i t in r e l a t i o n to c o n t i n u i n g e d u c a t i o n . Weaver (1977) s t a t e s that the h e a l t h care f i e l d i s becoming i n c r e a s i n g l y focussed on those people who are outside the range of e x i s t i n g c o n t i n u i n g education f a c i l i t i e s for whatever reason, be i t p h y s i c a l d i s a b i l i t y , employment r e s t r i c t i o n , or geographic remoteness. He contends that planners i n c o n t i n u i n g education must do e v e r y t h i n g i n t h e i r power to h e l p the remote student, except to lower the standards of the program. Wagner (1977) d i s c u s s e s the r e l a t i o n s h i p between education programs and geographic remoteness and observes that d i s t a n c e w i l l i n f l u e n c e both who w i l l p a r t i c i p a t e and t h e i r chances of s u c c e s s f u l completion of a program. He suggests that i n order to overcome the b a r r i e r of geographic remoteness, a d i s t a n c e education philosophy and d i s t a n c e d e l i v e r y systems must be c o n s i d e r e d . In her review of the l i t e r a t u r e , Nakamoto (1973) emphasizes the f a c t t h a t the geographic d i s t r i b u t i o n of h e a l t h p r o f e s s i o n a l s has been a b a r r i e r to the systematic development of c o n t i n u i n g education. She observes that the e f f e c t s of 25 geographic d i s t r i b u t i o n are more profoundly f e l t i n Canada than the United S t a t e s because of the comparatively low d e n s i t y p o p u l a t i o n p a t t e r n that i s c h a r a c t e r i s t i c of Canada. As a r e s u l t of the d i s t r i b u t i o n p a t t e r n , there e x i s t s a l a r g e number of sponsoring agencies o f f e r i n g programs to h e a l t h p r o f e s s i o n a l s . The lack of c o - o r d i n a t i o n and communication between these agencies c r e a t e s redundancy in programming and i n e f f i c e n t use of the funds that are a v a i l a b l e for c o n t i n u i n g e d u c a t i o n . In the o case of o c c u p a t i o n a l therapy, Dickson (Note 3) r e p o r t s that there are a number of sources of continung education f o r t h e r a p i s t s i n c l u d i n g : r e g i o n a l and p r o v i n c i a l p r o f e s s i o n a l groups, u n i v e r s i t i e s , h o s p i t a l s , treatment c e n t e r s , and s p e c i a l i n t e r e s t groups. The geographic l o c a t i o n of o c c u p a t i o n a l t h e r a p i s t s in B r i t i s h Columbia was s t u d i e d by McGregor (Note 5) who found that approximately 20% of the t h e r a p i s t p o p u l a t i o n was employed i n a r u r a l s e t t i n g . She s t a t e d that t h i s d i s t r i b u t i o n c o u l d be accounted f o r i n a number of ways, but she concluded that i t was l a r g e l y based on f a c i l i t y d i s t r i b u t i o n . The c o n c e n t r a t i o n of t h e r a p i s t s i n urban areas r e f l e c t e d the f a c t that the major te a c h i n g h o s p i t a l s and r e h a b i l i t a t i o n c enters are l o c a t e d i n e i t h e r V i c t o r i a or Vancouver. T h e r a p i s t s are o f t e n r e l u c t a n t to r e l o c a t e away from these s p e c i a l t y c e n t e r s where they c o n s i d e r experience i s best gained. Devereaux (1978) s t a t e s that many o c c u p a t i o n a l t h e r a p i s t s p r a c t i s i n g i n r u r a l areas of the U n i t e s S t a t e s are newly graduated and are there e i t h e r because of i n a b i l i t y to secure employment i n a m e t r o p o l i t a n area or f o r p e r s o n a l reasons. In a 26 more recent study of the geographic d i s t r i b u t i o n of therapists in the United States, Langwell, Wilson, and Deane (1981) concluded that a geographic maldistribution in the occupation was evident. They found that the numbers of therapists in a given geographic region related d i r e c t l y to the population size and per capita income. In relation to the nature of the rural setting, the study revealed that 77% of the counties having r e l a t i v e l y low numbers of therapists (0-5) were in rural areas; a finding which supports the notion of professional i s o l a t i o n . The relationship between geographic i s o l a t i o n and continuing education was described by Bennett (1979) in her model of program development for use in semi-rural settings. She i d e n t i f i e d a number of barriers to the development of and p a r t i c i p a t i o n in programs including scarcity of t r a d i t i o n a l academic resources, decreased access to'experts and potential faculty, a small number of participants to support programs, and the trav e l r e s t r i c t i o n s imposed by geographic remoteness. The most frequently stated result of geographic remoteness in the l i t e r a t u r e i s professional i s o l a t i o n . Several studies investigating the reasons why health professionals do not practise in rural areas suggest that the fear of professional i s o l a t i o n and i t s effects on competent practise i s a major factor (Castleton, 1970; Heald, Cooper, and Coleman, 1973; Taylor, Dickman, and Kane, 1973). Respondents id e n t i f y opportunity to keep current, opportunity for professional consultation, and access to medical school or centers as important to the decision of where to locate. Such findings suggest that the lack of supportive health care f a c i l i t i e s and 27 p r o f e s s i o n a l s in r u r a l areas produce a demand for c o n t i n u i n g education o p p o r t u n i t i e s that w i l l attempt to minimize the f e e l i n g s of p r o f e s s i o n a l i s o l a t i o n . C o n t i nuing education then, can be seen as one a l t e r n a t i v e to the d a i l y p r o f e s s i o n a l interchange with c o l l e a g u e s from which many t h e r a p i s t s i n r u r a l areas are unable to b e n e f i t . In her d e s c r i p t i o n of o c c u p a t i o n a l therapy i n the r u r a l s e t t i n g Devereaux (1978) s t a t e s that being the only t h e r a p i s t i n the community can be a l o n e l y experience p r o f e s s i o n a l l y . She acknowledges the lack of a c c e s s i b l e c o n t i n u i n g education o f f e r i n g s and suggests that t h e r a p i s t s develop t h e i r own programs. In order to keep abreast of i s s u e s and concepts i n v o l v e d i n c u r r e n t p r a c t i s e , she recommends that the r u r a l t h e r a p i s t read j o u r n a l s , u t i l i z e i n t e r l i b r a r y loans, and exchange reading m a t e r i a l with other a l l i e d p r o f e s s i o n a l s . There i s some evidence to suggest that p r o f e s s i o n a l i s o l a t i o n i s not an i n e v i t a b l e consequence of geographic remoteness i n the h e a l t h care f i e l d . Ducker's (1977) survey of r u r a l p h y s i c i a n s concluded that p r o f e s s i o n a l i s o l a t i o n was not a major concern. In h i s sample, many of the p h y s i c i a n s viewed the f a c t that they were i n a r u r a l s e t t i n g as a m o t i v a t i n g f o r c e which i n c r e a s e d t h e i r p a r t i c i p a t i o n i n c o n t i n u i n g education programs. Because many of the resources were not a v a i l a b l e to r u r a l p r a c t i t i o n e r s , a more determined i n d i v i d u a l e f f o r t was made and more inconvenience accepted by the i n d i v i d u a l i n an e f f o r t to keep knowledge and s k i l l s c u r r e n t . Although there i s evidence that r u r a l p o p u l a t i o n s are disadvantaged because of t h e i r remoteness,it appears that i n some cases those 28 p r o f e s s i o n a l s i n the o u t l y i n g areas a t t e n d more c o n t i n u i n g education programs and are more s a t i s f i e d by them than t h e i r urban c o l l e a g u e s . Learning Needs "Need" i s among the most commonly used terms in a d u l t and c o n t i n u i n g education. Archambault (1966) s t a t e s that i t s high p r o f i l e can be t r a c e d to the e d u c a t i o n a l philosophy which emphasizes l e a r n e r - c e n t e r e d e d u c a t i o n a l o p p o r t u n i t i e s . The p o p u l a r i l t y of the term however, has c o n t r i b u t e d to the o b s c u r t i y of i t s meaning ( G r i f f i t h , 1978; Komisar, 1961). Monette (1977) s t a t e s that the most gen e r a l use of the term "need" i n the e d u c a t i o n a l sense i s in the i d e n t i f i c a t i o n of a d e f i c i e n t s t a t e . The d e f i c i e n t s t a t e i s a r e s u l t of a d i s c r e p a n c y between an e x i s t i n g s t a t e and a d e s i r e d one. Atwood and E l l i s (1971) propose the term " r e a l e d u c a t i o n a l need" to d e s c r i b e a c a r e f u l l y e s t a b l i s h e d d e f i c i e n c y which d e t r a c t s from the w e l l - b e i n g of the l e a r n e r ; one that i s c o r r e c t a b l e through a l e a r n i n g experience. There are a number of v a r i a n t s of the term need in common use i n the education l i t e r a t u r e . Knowles (1975) d i s t i n g u i s h e s between " o p e r a t i o n a l or process" needs and " e d u c a t i o n a l or l e a r n i n g " needs. E d u c a t i o n a l needs are those that are capable of being s a t i s f i e d by means of an e d u c a t i o n a l experience while o p e r a t i o n a l ones, by i m p l i c a t i o n , can not be met through e d u c a t i o n a l e x p e r i e n c e s . B a s i c human needs have been d e s c r i b e d in the l i t e r a t u r e as a b i o - p s y c h o l o g i c a l s t a t e s i m i l a r to d r i v e 29 which i n i t i a t e s a motive on the p a r t of the i n d i v i d u a l (Kendler, 1961). Monette (1977) argues, however, that the b a s i c human needs in program planning are not r e l e v a n t to the educator's task and suggests that "need" be r e p l a c e d by the term "m o t i v a t i o n " in reference to program p l a n n i n g . A major d i s t i n c t i o n i s made in the l i t e r a t u r e between f e l t , and normative e d u c a t i o n a l needs. Bradshaw (1974) s t a t e s that f e l t needs are synonomous with d e s i r e s , wants, and i n t e r e s t s and that normative needs denoted an o b j e c t i v e e v a l u a t i o n or o p i n i o n by an e x p e r t . Archaubault (1966) uses the term "genuine need" to d e s c r i b e a need based on o b j e c t i v e l y demonstrable d e f i c i e n c y and d i s c o u n t s the s u b j e c t i v e d e f i n i t i o n of need by the i n d i v i d u a l . The a d j e c t i v e " p r e s c r i b e d " i s a l s o f r e q u e n t l y used in c o n t i n u i n g education and i m p l i e s a need r e l a t i v e to s p e c i f i c o b j e c t i v e s , standards, or o b l i g a t i o n s . Koonz (1978) i d e n t i f i e s the d i f f e r e n c e between f e l t and normative need as s e l f - p e r c e i v e d wants compared to an o b j e c t i v e e s t i m a t i o n of a d e f i c i e n c y based on comparison to a minimum standard. The key issue surrounding the concept of need a c c o r d i n g to Monette (1977) and Knox (1968) i s that some educators b e l i e v e a need i s only a need when i t i s recognized as such by the p o t e n t i a l l e a r n e r , thereby p r o v i d i n g m o t i v a t i o n to c l o s e the gap or reduce the d i s c r e p a n c y . P o p i e l (1977) s t a t e s that s i n c e a d u l t l e a r n e r s enter e d u c a t i o n a l programs v o l u n t a r i l y , s e l e c t i n g programs on the b a s i s of f e l t need i s e s s e n t i a l . Others contend that needs are b e t t e r recognized by o b j e c t i v e i n d i v i d u a l s and that f e l t needs are not a v a l i d source of i n f o r m a t i o n (Atwood and E l l i s , 197-1; Bradshaw, 1974.) 30 These two uses of the term need form the b a s i s of the issue of who can best assess the l e a r n i n g needs of h e a l t h p r o f e s s i o n a l s . Bradshaw (1974) a s s e r t s that assessments of f e l t need i n h e a l t h care are t y p i c a l l y inadequate because they are l i m i t e d by the p e r c e p t i o n of the i n d i v i d u a l and may t h e r e f o r e not be i n d i c a t o r s of v a l i d needs. Koonz (1978) s t a t e s that r e a l e d u c a t i o n a l needs are generated by changes i n the d e l i v e r y of h e a l t h care and that because of the g l o b a l and f a r - r e a c h i n g e f f e c t s of these changes, needs may not be p e r c e i v e d by the i n d i v i d u a l h e a l t h care p r a c t i t i o n e r . P o p i e l (1977) and P r i c e (1967) maintain, however, that needs are best recognized by the p o t e n t i a l l e a r n e r i n order that m o t i v a t i o n i s c r e a t e d . Smallgren (1981) i n v e s t i g a t e d f e l t vs normative needs i n r e l a t i o n to the development of c o n t i n u i n g education programs. She d e f i n e s the programs that are q u i c k l y f i l l e d as meeting f e l t needs but advocates that normative needs are important. She s t a t e s that c o n t i n u i n g education programs have a l e a d e r s h i p f u n c t i o n in h e l p i n g normative or fu t u r e needs become f e l t as present needs. Programs must move between c o n s i d e r i n g needs apparent to everyone, needs that e x i s t but may not be apparent, and f u t u r e needs. Chatham (1979) focuses on the d i f f e r e n c e s between needs i d e n t i f i e d by an ad v i s o r y committee which she terms normative needs assessment and f e l t needs i d e n t i f i e d by p r a c t i s i n g nurses. She d e f i n e s normative need as the s u p e r v i s o r ' s or group of s u p e r v i s o r s ' judgement of what s k i l l s and knowledge are needed by the s t a f f to best perform the job at some pre-determined l e v e l of competence. In her c o n c l u s i o n s she q u e r i e s the b a s i s upon which the normative assessments are made 31 but she does not address t h i s q u e s t i o n in her study. I t i s i n t e r e s t i n g to note that Chatham's study was the only one reviewed which attempted to p r e d i c t i n which areas d i f f e r e n c e s in l e a r n i n g need would occur. She hypothesized that s u p e r v i s o r ' s would i d e n t i f y p r o c e s s - o r i e n t e d needs i n r e l a t i o n to c l i n i c a l p r a c t i s e while c l i n i c i a n s themselves would i n d i c a t e needs based on a lack of f a c t u a l l y - o r i e n t e d i n f o r m a t i o n . In other words, normative assessment would i d e n t i f y how goals were being achieved and f e l t need assessment would emphasize what was being done as areas where l e a r n i n g was r e q u i r e d . The data supported t h i s hypothesis but there was was no d i s c u s s i o n of why these d i f f e r e n c e s occured. Needs Assessment A fundamental p r i n c i p l e of c o n t i n u i n g education concerns the importance of conducting a needs assessment before p l a n n i n g and implementing a program. Needs assessment r e f e r s to a t e c h n i c a l process wherein an i n d i v i d u a l ' s or o r g a n i z a t i o n ' s f u n c t i o n a l requirements are i d e n t i f i e d . Knox (1975) s t a t e s the b a s i c premise behind the assessment of need i s that a p a r t i c i p a n t i s u n l i k e l y to change much unless a gap i s i d e n t i f i e d between present performance and changed performance that i s deemend d e s i r a b l e . L o g i c a l l y the program development process begins with problem i d e n t i f i c a t i o n and needs assessment ( P o p i e l , 1977). The problem may be d e f i n e d in a number of ways i n c l u d i n g i n a p p r o p r i a t e personnel assignment, low s t a f f morale, or lack of a s p e c i f i c s k i l l or competence. Needs assessments are then conducted t o . i d e n t i f y ways i n which problems can be reduced 32 through c o n t i n u i n g education e f f o r t s . Nowlen (1980) s t a t e s that the b e n e f i t s of needs assessment are t h r e e f o l d . F i r s t l y , adequate needs assessment provides a b a s i s f o r more re l e v a n t programs. In a d d i t i o n , c o n s i d e r i n g the l i m i t e d resources that are a v a i l a b l e , needs assessment can y i e l d a l i s t of p o t e n t i a l program areas i n order of p r i o r i t y . A f u r t h e r use i s to document e x i s t i n g need in order to support funding r e q u e s t s . In a d d i t i o n , planning without a needs assessment may create a lack of c o n t i n u i t y f o r the i n d i v i d u a l l e a r n e r and provide i r r e l e v a n t programs at the expense of much needed o p p o r t u n i t i e s . Houle (1972) maintains that some program planners labour under the g e n e r a l i z e d n o t i o n that everyone ought to l e a r n more than they know; a notion which f o s t e r s the "more i s b e t t e r " p o l i c y in program p l a n n i n g . He advocates the d i a g n o s i s of e d u c a t i o n a l need as a method of pr e v e n t i n g the p r o l i f e r a t i o n of programs with minimal or no u n d e r l y i n g r a t i o n a l e . Despite the widespread acceptance of the p r i n c i p l e of needs assessment, a comprehensive needs a n a l y s i s of p r o f e s s i o n a l s i s r a r e l y c a r r r i e d out (Quastel, Note 5). There appears to be a gen e r a l consensus in the l i t e r a t u r e that needs assessment i s a complicated task, t y p i c a l l y i n v o l v i n g more than one procedure i f i t i s to be adequate, and that the time necessary to c a r r y out a proper assessment i s o f t e n p r o h i b i t i v e to the program planner. Knox (1980) i d e n t i f i e s four methods of needs assessment t h a t are commonly used i n a d u l t e d u c a t i o n . These c a t e g o r i e s w i l l be used to d e s c r i b e the v a r i e t y of needs assessment found i n the l i t e r a t u r e on c o n t i n u i n g education i n the h e a l t h care f i e l d . 33 Comprehensive d e s c r i p t i o n s of assessment techniques are presented by L o r i g (1977), B e l l (1978), and C o l l a r t (1976), however, only the most p r e v a l e n t w i l l be i n c l u d e d here. The most common assesssment procedure c o n s i s t s of o f f e r i n g e d u c a t i o n a l o p p o r t u n i t i e s and then e v a l u a t i n g the numbers and types of p a r t i c i p a n t s . The approach of o f f e r i n g a sample program i s o f t e n used to estimate a p o t e n t i a l market. One method of using t h i s technique i s to conduct a survey at the end of the program; p a r t i c i p a n t s are asked to complete a r e a c t i o n or e v a l u a t i o n form that asks for t o p i c s i n which they would be i n t e r e s t e d in the f u t u r e . Smallgren (1981) s t a t e s that workshop e v a l u a t i o n s are a f a i r l y accurate i n d i c a t i o n of the needs of c l i n i c i a n s who are l i k e l y to a t t e n d s i m i l a r programs. T h i s method i s most of t e n used in the s e t t i n g where a l a r g e number of programs are o f f e r e d , one which has the resources to plan on a " t r i a l and e r r o r " b a s i s . The program sources i n o c c u p a t i o n a l therapy would l i k e l y c o n s i d e r t h i s method r e l a t i v e l y r i s k y and c o s t l y c o n s i d e r i n g the l i m i t e d number of programs that o f f e r e d . The second type of assessment procedure d e s c r i b e d by Nowlen i s the i n t e r e s t i n v e n t o r y . The most commom form i s the q u e s t i o n n a i r e composed of a l i s t of t o p i c s to which respondents are asked to i n d i c a t e the extent of t h e i r i n t e r e s t in l e a r n i n g about each t o p i c . T h i s assessment taps f e l t or p e r c e i v e d needs i n a s p e c i f i c program or subject a r e a . Although used e x t e n s i v e l y in the l i t e r a t u r e reviewed (Hightower, 1973; McGregor, Note 5; P r i c e , 1977; Smallgren, 1981), Hiemstra and Long (1974) found t h i s method to be inadequate because i n t e r e s t does not always i n d i c a t e the e x i s t e n c e of an e d u c a t i o n a l need. 34 A t h i r d type of needs assessment procedure depends on experts f a m i l i a r with the group of p o t e n t i a l l e a r n e r s to estimate t h e i r e d u c a t i o n a l needs. These normative needs assessments are f r e q u e n t l y c a r r i e d out by an a d v i s o r y committee made up of experts in the p a r t i c u l a r f i e l d . Johnson and Ware (1967) support the use of normative assessment in physiotherapy and d e s c r i b e the r o l e of the educator as p r o v i d i n g o p p o r t u n i t y for c o l l e g u e s not only to maintain t h e i r present l e v e l of competency but a l s o to a n t i c i p a t e and prepare fo r f u t u r e demands. In t h e i r e s t i m a t i o n , p o t e n t i a l p a r t i c i p a n t s need not be represented d i r e c t l y i n the d i a g n o s i s of need. Normative assessment may a l s o take the form of a n a l y s i s of s t a t i s t i c a l data, a c c r e d i t a t i o n r e p o r t s , c r i t i c a l i n c i d e n t notes, or c h a r t audi t f o r example. Walsh (1981) proposes a new system of c o n t i n u i n g education p l a n n i n g based on a s s e s s i n g need in r e l a t i o n to p a t i e n t care data and o r g a n i z i n g programs around c l i n i c a l problems rather than s p e c i f i c h e a l t h care p r o f e s s i o n s or d i s c i p l i n e s . He suggests a number of sources of data i n c l u d i n g : morbidity and m o r t a l i t y r a t e s , r e c i d i v i s m r a t e s , review s t u d i e s , and p a t i e n t s a t i s f a c t i o n surveys. Nowlen d e s c r i b e s one of the most e f f e c t i v e needs assessment procedures as o c c u r i n g i n c o n j u n c t i o n with performance review. Both employers and employees d e s c r i b e a c t u a l job performance along with d e s i r e d changes and improvements, the purpose of the e v a l u a t i o n being to i d e n t i f y the gap between c u r r e n t and d e s i r e d competence. Le s s i n g e r (1974) d e s c r i b e s the use of job a n a l y s i s as important i n i d e n t i f y i n g the p r e c i s e gaps i n knowledge that can be addressed through t r a i n i n g . P o p i e l (1977) a l s o d e s c r i b e s 35 the use of performance e v a l u a t i o n s i n the n u r s i n g f i e l d as a u s e f u l procedure in determining t r a i n i n g needs. Another method that i s i n common use not mentioned by Nowlen i s the planning committee c o n s i s t i n g of represent i t i v e s of the c l i e n t group with which the p r o f e s s i o n a l i s working. In the h e a l t h care f i e l d these may i n c l u d e , r e p r e s e n t i t i v e s of p a t i e n t support groups, stroke or burn p a t i e n t s for example, or advocates of c l i e n t s , parents of d i s a b l e d c h i l d r e n f o r example. Because of the number and d i v e r s i t y of s t u d i e s r e p o r t i n g the r e s u l t s of l e a r n i n g needs assessments i n the h e a l t h care f i e l d , a summary of the i n f o r m a t i o n i s i m p r a c t i c a l . A number of i n v e s t i g a t i o n s , however, have concluded that c l i n i c a l l y o r i e n t e d programs are more f r e q u e n t l y i n d i c a t e d on assessments than other types of programs, such as human r e l a t i o n s , a d m i n i s t r a t i v e , or l i b e r a l s t u d i e s . Hightower (1973) and McGregor (Note 5) concluded that physio and o c c u p a t i o n a l t h e r a p i s t s are i n g r e a t e s t need of c o n t i n u i n g education programs with a c l i n i c a l o r i e n t a t i o n , p a r t i c u l a r i l y the areas of neurophysiology and o r t h o p a e d i c s . C a f f e r a t a (1975), Ferguson (1971), and Chatham (1979) d i s t i n g u i s h between f a c t u a l and process o r i e n t a t i o n s i n l e a r n i n g needs i d e n t i f i e d by nurses. These three s t u d i e s found that the need f o r p r a c t i c a l treatment based programs were higher than that of administrative/management o r i e n t e d programs. P r i c e (1967) concluded that planners i n c o n t i n u i n g education would best meet the needs of c l i n i c a l nurses by o f f e r i n g programs on b a s i c s k i l l s i n f o r m a t i o n . Although these s t u d i e s r e f e r r i n g to d i f f e r e n c e s i n p e r c e p t i o n s have more l i m i t e d i m p l i c a t i o n s f o r 36 p l a n n e r s of programs in o c c u p a t i o n a l therapy than of nursing because of the s p e c i f i c nature of the samples used, they i l l u s t r a t e that d i f f e r e n c e s i n p e r c e p t i o n e x i s t . T h i s study attempted to i d e n t i f y s i m i l a r d i f f e r e n c e s i n the f i e l d of o c c u p a t i o n a l therapy. B a r r i e r s to P a r t i c i p a t i o n To e f f e c t i v e l y provide c o n t i n u i n g education programs, planners must be able to a c c u r a t e l y assess the r e l a t i v e impact of a wide v a r i e t y of f a c t o r s that s e r i o u s l y l i m i t attendance. Cross (1981) s t a t e s that i t i s the people who "need" education the most who f a i l to p a r t i c i p a t e . T y p i c a l l y planners c a r r y out needs assessments which c o n s i d e r p o t e n t i a l p a r t i c i p a n t s ; Cross maintains that b a r r i e r s to p a r t i c i p a t i o n i d e n t i f i e d by non- p a r t i c i p a n t s are e q u a l l y as important to the p l a n n i n g process. I d e n t i f i c a t i o n of these b a r r i e r s , then, can a s s i s t i n the development of programs which minimize b a r r i e r s thereby i n c r e a s i n g the a c c e s s i b i l i t y of the program. There are a number of methods for i d e n t i f y i n g b a r r i e r s to p a r t i c i p a t i o n , the most f r e q u e n t l y used being i n t e r v i e w s or q u e s t i o n n a i r e s . Survey q u e s t i o n n a i r e s provide a broad coverage of p o t e n t i a l b a r r i e r s and are u s e f u l i n i d e n t i f y i n g d i f f e r e n t b a r r i e r s f o r v a r i o u s p o p u l a t i o n subgroups. T h i s method, however, i s dependent upon the respondent's a b i l i t y to analyze t h e i r own behavior and to i n t e r p r e t the d e f i n i t i o n s of b a r r i e r s i n the same way that the i n v e s t i g a t o r does. In a d d i t i o n , survey respondents may i d e n t i f y some or a l l of the b a r r i e r s as 37 p e r t i n e n t to them and i f a ranking system i s not used, the i n f o r m a t i o n has l i m i t e d p r a c t i c a l v a l u e . Although both the q u e s t i o n n a i r e and i n t e r v i e w are time consuming procedures, the i n t e r v i e w i s advantageous i n that i t allows for c l a r i f i c a t i o n and v a l i d a t i o n of the d e f i n i t i o n s of the b a r r i e r s and o f t e n y i e l d s more d e t a i l e d i n f o r m a t i o n . A t h i r d method of i d e n t i f y i n g b a r r i e r s to p a r t i c i p a t i o n i s by observing p a r t i c i p a t i o n l e v e l s when one aspect of a program i s m o d i f i e d . Cross (1981) c i t e s a number of examples where the e f f e c t s of v a r y i n g cost and l o c a t i o n are c o nsidered in r e l a t i o n to d e c r e a s i n g these b a r r i e r s . The major d i f f i c u l t y with the i d e n t i f i c a t i o n of b a r r i e r s i s that s t u d i e s tend to be based on i n f o r m a t i o n d e r i v e d from p a r t i c i p a n t s in c o n t i n u i n g education. The non-respondents e l i m i n a t e d from these s t u d i e s are the i n d i v i d u a l s f o r whom b a r r i e r s are the most r e l e v a n t . In a d d i t i o n , the respondent's p e r c e p t i o n of b a r r i e r s i s dependent upon the method used to assess them, thus making i t d i f f i c u l t to compare and v a l i d a t e data on t h i s program p l a n n i n g v a r i a b l e . Cross (1981) i d e n t i f i e s three types of b a r r i e r s experienced by a d u l t l e a r n e r s : s i t u a t i o n a l , i n s t i t u t i o n a l , and d i s p o s i t i o n a l b a r r i e r s . She d e s c r i b e s s i t u a t i o n a l as the most p r e v a l e n t type and are those that a r i s e from one's s i t u a t i o n i n l i f e at any given time. T r a n s p o r t a t i o n would be a s i t u a t i o n a l b a r r i e r f o r those in a r u r a l area or the lack of c h i l d care f o r a p r o f e s s i o n a l with a f a m i l y , and i n s u f f i c e n t time a s i t u a t i o n a l b a r r i e r f o r the i n d i v i d u a l with heavy p r o f e s s i o n a l r e s p o n s i b i l i t i e s . I n s t i t u t i o n a l b a r r i e r s are those p r a c t i s e s and 38 procedures which exclude or discourage working a d u l t s from p a r t i c i p a t i n g i n e d u c a t i o n a l a c t i v i t i e s . These are r e l a t e d to program c h a r a c t e r i s t i c s and how they f i t with the i n d i v i d u a l ' s p e r s o n a l and v o c a t i o n a l s i t u t i o n . The most commonly i d e n t i f i e d b a r r i e r s of t h i s type are: s c h e d u l i n g , poor l o c a t i o n , l a c k of i n f o r m a t i o n about programs, and lack of s u i t a b l e programs. T h i s category would a l s o i n c l u d e p e r c e i v e d i r r e l e v a n c e of e x i s t i n g programs from the i n d i v i d u a l p a r t i c i p a n t ' s viewpoint or i n r e l a t i o n to the p r o f e s s i o n as a whole. A study by Ruyle and Geiselman (1974) revealed that by changing such f a c t o r s as schedule, admission p o l i c y , and l o c a t i o n , p a r t i c i p a t i o n was i n c r e a s e d . D i s p o s i t i o n a l b a r r i e r s are those r e l a t e d to a t t i t u d e s and s e l f - p e r c e p t i o n s about o n e s e l f as a l e a r n e r . Common examples i n c l u d e : lack of confidence in a b i l i t y to succeed, d i s i n t e r e s t in l e a r n i n g , and i n s u f f i c i e n t energy. Although d i s p o s i t i o n a l b a r r i e r s are l e a s t o f t e n i d e n t i f i e d , Cross suggests that these are underestimated because i t i s s o c i a l l y and p r o f e s s i o n a l l y unacceptable to i d e n t i f y b a r r i e r s of t h i s type. Although these three types of b a r r i e r s are u s e f u l i n o r g a n i z i n g the numerous types of b a r r i e r s that l e a r n e r s i d e n t i f y , i t should be noted that many b a r r i e r s f i t i n t o more than one category and may change c a t e g o r i e s over a p e r i o d of time. Cost f o r example, i s commonly i d e n t i f i e d as a s i t u a t i o n a l b a r r i e r but i t c o u l d be viewed as f i t t i n g the d i s p o s i t i o n a l category in that w i l l i n g n e s s to pay and a b i l i t y to pay are separate c o n s i d e r a t i o n s . In some cases an i n d i v i d u a l may be w i l l i n g to pay more t u i t i o n f o r a program that advances t h e i r c a r e e r than one that i s based soley on p e r s o n a l i n t e r e s t s . 39 L i k e w i s e , job r e s p o n s i b i l t y as a b a r r i e r f r e q u e n t l y a r i s e s from an i n d i v i d u a l ' s s i t u a t i o n but i n the case of programs with unreasonable or i n f l e x i b l e schedules, i t would be c l a s s e d as an i n s t i t u t i o n a l b a r r i e r . The c o n t i n u i n g education l i t e r a t u r e r e f l e c t s a number of f i n d i n g s s i m i l a r to Cross's (1981) review of a d u l t l e a r n e r s . Cost, d i s t a n c e to t r a v e l , family r e s p o n s i b i l i t y , and job r e l a t e d r e s p o n s i b i l i t y were the most f r e q u e n t l y i d e n t i f i e d b a r r i e r s o v e r a l l . Studies by Seymour, Co n n e l l y , and Gardener (1979), B r o s k i and Upps (1979), Rodowskas and Evanson (1969), and Wechler (1969) suggest that these four b a r r i e r s are commonly experienced by a number of h e a l t h p r o f e s s i o n a l s i n c l u d i n g nurses, pharmacists, t h e r a p i s t s , and p h y s i c i a n s . A l l of the s t u d i e s reviewed made ref e r e n c e to job r e l a t e d r e s p o n s i b i l i t i e s as a major b a r r i e r . A study by Greenberg, Edelstei'n, and B e n e l l (1978) posed the q u e s t i o n of whether the statement of job r e s p o n s i b i l i t y as a b a r r i e r was based on the employees' p e r c e p t i o n of the s i t u a t i o n or t h e i r employer's p e r c e p t i o n . I t was suggested that the employer's e v a l u a t i o n of the p o t e n t i a l p a r t i c i p a n t ' s l e v e l of r e s p o n s i b i l i t y i n r e l a t i o n to being 0 absent from work in order to a t t e n d a c o n t i n u i n g education program may be what i s r e f l e c t e d i n j o b - r e l a t e d b a r r i e r s . A study by Peterson (1975) addresses the issue of d i f f e r e n c e s i n p e r c e p t i o n of b a r r i e r s and although the sample was not composed of h e a l t h care p r o f e s s i o n a l s , the f i n d i n g s are of i n t e r e s t to program p l a n n e r s . The i n v e s t i g a t i o n compares community l e a d e r ' s p e r c e p t i o n s of what people in t h e i r community would p e r c e i v e as b a r r i e r s to c o n t i n u i n g education to s e l f - p e r c e p t ions of 40 i n h a b i t a n t s of the community. The major f i n d i n g was that l e a d e r s assigned higher importance to d i s p o s i t i o n a l b a r r i e r s than community r e s i d e n t s , a c o n c l u s i o n with i n t e r e s t i n g i m p l i c a t i o n s f o r the way programs are presented and the t o p i c s that planners develop. For example, l e a d e r s might base planning d e c i s i o n s on the p a r t i c i p a n t s ' low s e l f esteem or f e a r of r e t u r n i n g to study and attempt to overcome these p e r c e i v e d b a r r i e r s by i n t r o d u c i n g some type of p s y c h o l o g i c a l supports i n t o the program. P a r t i c i p a n t s f o r whom inconvenient s c h e d u l i n g or f a m i l y r e s p o n s i b i l i t i e s are a problem would l i k e l y r e a ct a g a i n s t the planners' assumptions. Two s t u d i e s were reviewed that r e l a t e d s p e c i f i c a l l y to the area of r e h a b i l i t a t i o n , i n c l u d i n g both physio and o c c u p a t i o n a l t h e r a p i s t s as a sample. McGregor (Note 5) found that 49% of o c c u p a t i o n a l t h e r a p i s t s and 32% of p h y s i o t h e r a p i s t s s t a t e d that t h e i r e d u c a t i o n a l needs were not being met through the e x i s t i n g programs. Of those who s t a t e d t h e i r needs were not being met, 73% i d e n t i f i e d lack of s u i t a b l e courses as the major b a r r i e r with f a m i l y r e s p o n s i b i l t y and l a c k of f i n a n c i a l support c o n t r i b u t i n g to t h e i r i n a b i l i t y to p a r t i c i p a t e i n programs. S i m i l a r r e s u l t s were reported by Seymour, Connelly, and Gardener (1979) with the a d d i t i o n of inconvenient s c h e d u l i n g as a major b a r r i e r . The l i t e r a t u r e review re v e a l e d only one study which represented a major disagreement with the f i n d i n g s d e s c r i b e d above. Smorynski and Panocha's (1979) survey of a l l i e d h e a l t h p r o f e s s i o n a l s suggested that cost was not a s i g n i f i c a n t b a r r i e r to p a r t i c i p a t i o n i n c o n t i n u i n g e d u c a t i o n . Although l o c a t i o n and 41 lack of time were important c o n s i d e r a t i o n s i n the d e c i s i o n to attend a c o n t i n u i n g education program, cost was one of the l a s t f a c t o r s to be con s i d e r e d i n the decision-making pr o c e s s . A number of s t u d i e s i n c l u d e d s p e c i f i c recommendations f o r program planners i n c o n t i n u i n g education to help decrease b a r r i e r s to p a r t i c i p a t i o n . The O n t a r i o Survey of Nurses (1969) concluded that i t i s d i f f i c u l t f o r p o t e n t i a l p a r t i c i p a n t s to plan to atte n d c o n t i n u i n g education programs when l i t t l e advance n o t i c e of course o f f e r i n g s i s g i v e n . Nurses are r e l u c t a n t to take advantage of o p p o r t u n i t i e s a v a i l a b l e when c o s t s of at t e n d i n g courses on short n o t i c e p r o h i b i t i t s i n c l u s i o n i n the agency budget. The m o d i f i c a t i o n of i n s t i t u t i o n a l b a r r i e r s as a method of i n c r e a s i n g p a r t i c i p a t i o n was suggested by Greenberg, E d e l s t e i n , and B e n e l l (1978) i n r e l a t i o n to f a c t o r s such as day of the week, time of day , and o f f e r i n g programs i n o u t l y i n g areas. Bennett (1979) s t a t e s that d e c e n t r a l i z i n g program l o c a t i o n i s l i k e l y the most e f f e c t i v e means of minimizing the b a r r i e r of geographic remoteness. D e l i v e r y Systems D e l i v e r y systems are d e f i n e d as a means of making l e a r n i n g o p p o r t u n i t i e s a c c e s s i b l e to the p o t e n t i a l l e a r n e r (Gobert, Note 4). The term i m p l i e s an a c t i v i t y on the p a r t of a resource person intended to c r e a t e o p p o r t u n i t i e s f o r l e a r n i n g and to provide a means of making those o p p o r t u n i t i e s a v a i l a b l e . One of the major tasks of the program planner in c o n t i n u i n g education i s to determine the most r e l e v a n t d e l i v e r y system c o n s i d e r i n g 42 the p o t e n t i a l p a r t i c i p a n t s , o b j e c t i v e s and program content. Within the program p l a n n i n g l i t e r a t u r e a number of terms have been used i n connection with d e l i v e r y systems i n c l u d i n g : format,- method, and medium a l l of which are more or l e s s i n t erchangable with'the term d e l i v e r y systems as i t a p p l i e s to program planning in t h i s study. D e l i v e r y systems can be c a t e g o r i z e d or grouped together i n a number of ways. T y p o l o g i e s can be based on the number of people i n attendance, the amount of audience p a r t i c i p a t i o n , or the major type of media used. One of the most f r e q u e n t l y r e f e r r e d to t y p o l o g i e s i s Verner's (1962) c l a s s i f i c a t i o n of the processes of a d u l t education i n which three elements are d e s c r i b e d : method, technique, and d e v i c e . Although Verner has c l a s s i f i e d numerous forms f o r p r e s e n t i n g a d u l t education o p p o r t u n i t i e s , the l i t e r a t u r e t y p i c a l l y mixes the terms and i t i s d i f f i c u l t to compare the nature of one system with another. Gobert (Note 4) d e s c r i b e s f i v e types of d e l i v e r y systems: home study, off-campus courses, mass-media based, i n s t r u c t i o n a l - media based, and community i n i t i a t e d . Although t h i s c l a s s i f i c a t i o n i s r e l e v a n t to the nature of the study of c o n t i n u i n g education i n o c c u p a t i o n a l therapy, i t was p r i m a r i l y used to d e s c r i b e d e l i v e r y systems designed f o r use i n r u r a l areas o n l y . In the present study, d e l i v e r y systems w i l l be c o n s i d e r e d as e i t h e r d i r e c t systems or d i s t a n c e d e l i v e r y systems. Examples of a d i r e c t system i n c l u d e : workshops, seminars, and short courses while d i s t a n c e systems a p p l i e s t o correspondence courses, e d u c a t i o n a l t e l e v i s o n , and audiotapes. 43 Di r e c t D e l i v e r y Systems A review of the l i t e r a t u r e r e v e a l s that the d i r e c t type of system i s by f a r the most commonly used i n c o n t i n u i n g p r o f e s s i o n a l education in the h e a l t h care f i e l d . The common 'element i n these systems i s that the p a r t i c i p a n t and the resource person meet face to face and i n t e r a c t d i r e c t l y with each other. V a r i a t i o n s of the t r a d i t i o n a l workshop systems are the most common example of ^the d i r e c t system and i n c l u d e : l e c t u r e s , symposiums, seminars, and s i n g l e day b r a i n storming s e s s i o n s . D i r e c t d e l i v e r y systems may be continuous i n nature, as in the one or two day workshop, or i n t e r m i t t e n t , which d e s c r i b e s systems where there i s at l e a s t a one day break between program p a r t s as occurs in short courses. The continuous systems are more common in the h e a l t h care f i e l d . I n t e r m i t t e n t programs o f t e n i n c o r p o r a t e p r o j e c t s or tasks f o r the p a r t i c i p a n t s to complete in the i n t e r v a l between program p a r t s i n order to r e i n f o r c e l e a r n i n g (Nakamoto, 1973). Hi s s (1976) d e s c r i b e s two d i r e c t approaches to c o n t i n u i n g education based on the agency i n i t i a t i n g the program. The f i r s t of these i s the formal program organized by a c o - o r d i n a t o r or planni n g committee that i s not connected with the work s e t t i n g . A two day workshop on a c l i n i c a l s p e c i a l i t y sponsored by the p r o f e s s i o n a l o r g a n i z a t i o n i s a common example of t h i s approach. The other approach d e s c r i b e s s t a f f programs that occur i n the work s e t t i n g . Grand rounds, v i s i t i n g l e c t u r e r s , or case p r e s e n t a t i o n s are examples of t h i s format. A t h i r d type of d i r e c t d e l i v e r y system that can be 44 d e s c r i b e d in terms of the i n i t i a t e r of the program are those systems which p r o f e s s i o n a l s i n i t i a t e to meet t h e i r own l e a r n i n g needs. Gobert (Note 4) comments that l e a r n e r - i n i t i a t e d systems are more pr e v a l e n t in c o n t i n u i n g education i n the h e a l t h s c i e n c e s than in other areas of a d u l t e d u c a t i o n . S p e c i a l i n t e r e s t groups and the f o r m a l i z e d programs that they conduct are the best example of t h i s type of d e l i v e r y system. Distanc e D e l i v e r y Systems Distance d e l i v e r y systems are based upon the p r i n c i p l e s of d i s t a n c e education which d e s c r i b e a form of study where the l e a r n e r and the resource person c a r r y out the e s s e n t i a l l e a r n i n g tasks and r e s p o n s i b i l i t i e s apart from each other. Keegan (1980) d e s c r i b e s the general c h a r a c t e r i s t i c s of a d i s t a n c e d e l i v e r y system as: p h y s i c a l s e p a r a t i o n of student and resource person, i n f l u e n c e of an e d u c a t i o n a l o r g a n i z a t i o n i n p l a n n i n g of l e a r n i n g m a t e r i a l s , use of t e c h n i c a l media, and the p o t e n t i a l f o r supplementary l e a r n i n g using a d i r e c t system. B r o o k f i e l d (Note 2) s t a t e s that d i s t a n c e d e l i v e r y systems are necessary in order to provide o p p o r t u n i t i e s f o r study to those i n d i v i d u a l s who are debarred from i t f o r whatever reason, be i t poverty, geographic remoteness, p h y s i c a l d i s a b i l i t y , or domestic or v o c a t i o n a l n e c e s s i t y . Although geographic l o c a t i o n i s the most commonly c i t e d reason f o r implementing d i s t a n c e systems, c o n s i d e r a t i o n of b a r r i e r s to p a r t i c i p a t i o n r e v e a l s a l t e r n a t e uses for d i s t a n c e d e l i v e r y systems. In the l i t e r a t u r e reviewed employment and f a m i l y r e s p o n s i b i l i t i e s were two major b a r r i e r s that c o u l d suggest to the planner that d i s t a n c e systems 45 may be a p p r o p r i a t e in m e t r o p o l i t a n areas as w e l l as r u r a l ones (Bennett, 1979, Cross, 1981). In the case of o c c u p a t i o n a l t h e r a p i s t s , working i r r e g u l a r s h i f t s , heavy employment schedules, or commitments to p r o f e s s i o n a l o r g a n i z a t i o n s c o u l d prevent the most w e l l - i n t e n t i o n e d t h e r a p i s t from a t t e n d i n g c o n t i n u i n g education programs based on d i r e c t systems. Distance systems then, should not be c o n s i d e r e d e x c l u s i v e l y from the p o i n t of view of overcoming geographic remoteness, rather in a broader sense where the p o t e n t i a l p a r t i c i p a n t ' s a c t u a l p h y s i c a l presence i s prevented r e g a r d l e s s of the reason. Wagner (1977) i d e n t i f i e s two b a s i c approaches to the use of d i s t a n c e d e l i v e r y systems that are commonly used, the i n d i r e c t m a t e r i a l s approach and the i n d i r e c t s i m u l a t i o n approach. The i n d i r e c t m a t e r i a l s approach d e s c r i b e s the case where prepared m a t e r i a l s are used in independent or group s i t u a t i o n s or i n the case where student resource c e n t e r s such as l i b r a r i e s are used. The resource person's r o l e i s b u i l t i n t o the m a t e r i a l to permit the l e a r n e r to i n t e r a c t with the m a t e r i a l j u s t as they would with a resource person i n a d i r e c t d e l i v e r y system. The most common examples of the i n d i r e c t m a t e r i a l s approach are the correspondence program and programmmed i n s t r u c t i o n . The i n d i r e c t s i m u l a t i o n approach i s used where techniques are employed to replace face to face i n t e r a c t i o n with an i n t e r a c t i o n that can be i n i t i a t e d by e i t h e r the resource person or the p a r t i c i p a n t . T h i s approach i n v o l v e s the use of some type of communication network, the most common examples being e d u c a t i o n a l t e l e v i s i o n , r a d i o , audio c a s s e t t e s and video c a s s e t t e s . MeKenzie, Postgate, and Scrupham (1975) s t a t e that 46 the r a p i d growth of these systems has made d i s t a n c e d e l i v e r y systems a c c e s s i b l e to the program planner for ge n e r a l use. Systems i n Cont inuing Educat ion Research in the area of d e l i v e r y systems i n c o n t i n u i n g education i s l i m i t e d to a small number of s t u d i e s which attempt to gather b a s e l i n e i n f o r m a t i o n . Data i s t y p i c a l l y d e r i v e d from one or two items .included w i t h i n a general survey on the t o p i c of c o n t i n u i n g education. In the h e a l t h care f i e l d , f i v e major d e l i v e r y systems i n common use have been i d e n t i f i e d by Nakamoto (1973): continuous systems or workshops, i n t e r m i t t e n t systems or short courses, c i r c u i t courses, home study, and b r o a d c a s t i n g . The f i r s t three of these . represent d i r e c t systems while the other two are examples of d i s t a n c e systems. She s t a t e s that by fa r the most p r e f e r r e d d e l i v e r y system i n the h e a l t h care f i e l d i s the d i r e c t type. Workshops and seminars appear to be u n i v e r s a l l y favored by h e a l t h care p r o f e s s i o n a l s as a method of p r e s e n t i n g continung education o p p o r t u n i t i e s . Studies by Broski and Upps (1979), Hightower (1973), and McGregor (Note 5) suggest that workshops, one or two days in length are p r e f e r r e d . Although the s t a t i s t i c s comparing workshops to other d e l i v e r y systems range from 62% - 92% in favor of workshops i n comparison to a l t e r n a t i v e s , a review of the instruments used in these s t u d i e s r e v e a l s a tendency to b i a s the response toward d i r e c t systems. Fr e q u e n t l y only one or two examples of d i s t a n c e systems are i n c l u d e d i n the survey, while four or f i v e of the d i r e c t systems make up the remainder. Of those s t u d i e s that i n c l u d e d a f a i r r e p r e s e n t a t i o n 47 of d i s t a n c e systems, between 7% and 20% of respondents p r e f e r r e d d i s t a n c e systems. A survey by Seymour, Connelly, and Gardener (1979) suggested that 21% of the nurses surveyed favor home study and 20% p r e f e r r e d b r o a d c a s t i n g systems. Greenberg, E d e l s t e i n , and B e n e l l (1978) examined d e l i v e r y systems from another p e r s p e c t i v e and found that the sample of nurses s t u d i e d p r e f e r r e d c o n t i n u i n g education programs based on non-involvement over those where p a r t i c i p a t i o n was necessary. In t h i s p a r t i c u l a r study, i t was the p e r s o n a l i n t e r a c t i o n which was the d i s c r i m i n a t i n g f a c t o r i n preference of d e l i v e r y systems. A study by the C a l i f o r n i a Medical A s s o c i a t i o n (1969) concluded that the three d i s t a n c e systems that were used by c o n t i n u i n g medical educators in that s t a t e were t e l e v i s i o n , r a d i o , and recorded m a t e r i a l . The study concluded that these d i s t a n c e systems were p e r c e i v e d by t h e i r users as supplementary to d i r e c t systems such as workshops and short courses. T h i s same study rep o r t e d that correspondence was the l e a s t popular means of d e l i v e r i n g i n f o r m a t i o n to the sample of doctors surveyed. The s p e c i f i c use of t e l e v i s o n i n the f i e l d of c o n t i n u i n g medical education was reviewed by Ramsay (1967) who s t a t e d that d e s p i t e p u b l i c i t y r e g a r d i n g i t s v a r i e d and widespread use, t e l e v i s i o n as a d e l i v e r y system has spread slowly. He suggests that i t s e f f f e c t i v e n e s s i s v a r i a b l e , the s i z e of the t a r g e t audience must be weighed a g a i n s t the c o s t of producing and b r o a d c a s t i n g programs. If the audience i s s m a l l , t e l e v i s i o n , a mass medium, may be l e s s cost e f f e c t i v e and e d u c a t i o n a l l y p r o d u c t i v e than other d e l i v e r y systems. Hunter (1968) and V a i l l a n t c o u r t and G i l l (1968) suggest 48 f i v e reasons why e d u c a t i o n a l t e l e v i s i o n i s not e f f e c t i v e i n c o n t i n u i n g education i n the h e a l t h care f i e l d . In order of t h e i r importance they are: f o r g e t t i n g to watch t e l e v i s o n , unaware of e x i s t e n c e of the program, i n s u f f i c e n t time, i n s u f f i c e n t depth of content, and lack of c o n t i n u i t y of programs. Nakamoto (1973) s t a t e s that although the .reach and v e r s a t i l i t y of b r o a d c a s t i n g are i n c r e a s i n g l y a t t r a c t i v e to program planners in c o n t i n u i n g education, problems in t e c h n i c a l p r o d u c t i o n and e v a l u a t i o n of e f f e c t i v e n e s s cause planners to be c a u t i o u s i n the use of t e l e v i s i o n as a d e l i v e r y system. The use of s a t e l l i t e s as an a l t e r n a t i v e to the d e l i v e r y of r a d i o and t e l e v i s i o n in the t r a d i t i o n a l manner has had a major « i n f l u e n c e on the use of d i s t a n c e d e l i v e r y systems. Polycn (1973) d e s c r i b e s a telecommunication s a t e l l i t e as a device which r e c e i v e s r a d i o waves from one p o i n t on e a r t h and r e t r a n s m i t s them to one or more other r e c e i v i n g s t a t i o n s . The refinement of t h i s technology has permitted the use of simpler and l e s s expensive r e c e i v i n g s t a t i o n s which has made t e l e v i s i o n a c c e s s i b l e to a g r e a t e r audience and thus of more p r a c t i c a l use in the f i e l d of c o n t i n u i n g education (Dahl, 1975). The use of d i r e c t b r o a d c a s t i n g s a t e l l i t e has r e c e n t l y been i n t r o d u c e d to h e a l t h p r o f e s s i o n a l s i n B r i t i s h Columbia. The Knowledge Network of the West (KNOW) i s a v a i l a b l e to h e a l t h care p r o f e s s i o n a l s through l o c a l community c o l l e g e s which have a r e c e i v i n g d i s h or in some cases on i n d i v i d u a l home t e l e v i s i o n s where the c a b l e s t a t i o n s r e c e i v e t r a n s m i s s i o n . At present, 62 c e n t e r s i n B r i t i s h Columbia enjoy the b e n e f i t s of a s a t e l l i t e e d u c a t i o n a l t e l e v i s i o n system. The use of the KNOW i s of most 49 obvious b e n e f i t to the g e o g r a p h i c a l l y i s o l a t e d i n d i v i d u a l or f o r those f o r whom t r a n s p o r t a t i o n i s a major b a r r i e r . Although the system i s now a v a i l a b l e f o r general use in c o n t i n u i n g education, the implementation of t h i s d e l i v e r y system w i l l r e q u i r e new s k i l l s from the program pla n n i n g p e r s p e c t i v e . The most c r u c i a l f a c t o r i n i t s use i s the development of an e f f e c t i v e set of m a t e r i a l s and a c t i v i t i e s designed to produce the d e s i r e d l e a r n i n g e x p e r i e n c e . Audio tapes t y p i c a l l y represent e d i t e d p o r t i o n s of l e c t u r e s , panels, symposia, and conference proceedings as w e l l as m a t e r i a l s p e c i f i c a l l y programmed for use on audio tapes. Although the l i t e r a t u r e r e v e a l s that audio tapes are used by a number of h e a l t h p r o f e s s i o n a l s , over 65% of them are used by p r o f e s s i o n a l s in r u r a l or non-metropolitan areas who have l i m i t e d access to d i r e c t d e l i v e r y systems ( A i t k e n , 1964). Another type of d e l i v e r y system that has l i m i t e d general use c u r r e n t l y i s the c i r c u i t course and t r a v e l l i n g l e c t u r e . Hodapp (1969) d e s c r i b e s c i r c u i t courses i n pharmacy as those where experts or c o n s u l t a n t s t r a v e l to f i v e or s i x d i f f e r e n t c i t i e s and meet with p r o f e s s i o n a l s who have done some pre- program p r e p a r a t i o n . S p i c e r (1975) d e s c r i b e s a s i m i l a r concept of the t r a v e l l i n g teacher as u s e f u l i n c o n t i n u i n g education i n n u r s i n g . Nakamoto (1973) d e s c r i b e s the d i s t a n c e d e l i v e r y system used by Dalhousie U n i v e r s i t y as one of the most e f f e c t i v e examples of the use of d i s t a n c e systems. The program i n v o l v e s 34 c e n t e r s each of which was v i s i t e d f i v e or s i x times per year by the medical f a c u l t y of the u n i v e r s i t y who acted as resources f o r a number of c o n t i n u i n g education t o p i c s . A trend that has 50 evolved from the c i r c u i t concept i s the use of community or non- teaching h o s p i t a l s as l e a r n i n g c e n t e r s with ongoing c o n t i n u i n g p r o f e s s i o n a l education planned and implemented with a s s i s t a n c e of the u n i v e r s i t y . A v a r i a t i o n of t h i s d e l i v e r y system employs a s p e c i a l l y equiped motor v e h i c l e to act as a t r a v e l l i n g resource c e n t e r . The Mobile I n s t r u c t i o n l Resource Center was used to d e l i v e r c o n t i n u i n g education i n o u t - l y i n g areas in B r i t i s h Columbia (Gobert, Note 4; McBain, 1970). Continuing education programs were made a v a i l a b l e to a l l i e d h e a l t h p r o f e s s i o n a l s in r u r a l B r i t i s h Columbia i n the form of audio v i s u a l l e a r n i n g programs a v a i l a b l e s p e c i f i c a l l y f o r updating the s k i l l s and knowledge of those i n the h e a l t h care f i e l d . Although the most common examples of d i s t a n c e d e l i v e r y systems i n c o n t i n u i n g education i n the h e a l t h f i e l d have been d e s c r i b e d , b r i e f mention should be made of the more i n f r e q u e n t l y used systems d e s c r i b e d i n the l i t e r a t u r e . The D i a l Access Program has been used i n the nu r s i n g f i e l d where pre-recorded tapes are played over the phone without charge. S t u d i e s i n d i c a t e that over 65% of the use i s between noon and midnight and that the m a j o r i t y of users are l o c a t e d i n r u r a l areas. Problems with t h i s system i n v o l v e c o - o p e r a t i o n with a telecommunication s e r v i c e and determining program content (Cooper and Hornback, 1973; Pearson, 1977). Few h e a l t h p r o f e s s i o n s have attempted to use correspondence programs with the exception of pharmacy and d e n t i s t r y . The u t i l i t y of t h i s system appears to be l i m i t e d to i t s use as a supplemental device to other systems, f o r example, in the case of pre-program reading or p r e p a r a t i o n . S i m i l a r l y programmed l e a r n i n g i s not a s i g n i f i c a n t f a c t o r i n c o n t i n u i n g 51 education in the h e a l t h care f i e l d . D e fined as a s e l f - i n s t r u c t i o n a l approach to l e a r n i n g i n which inf o r m a t i o n i s presented in a c o - o r d i n a t e d sequence of q u e s t i o n and answer steps, t h i s system has been used to a l i m i t e d extent i n pharmacy (Campbell, 1973). Mrtek (1971) suggests that s i m i l a r to the use of correspondence as a d e l i v e r y system, programmed l e a r n i n g i s most u s e f u l f o r remedial or supplementary purposes. Audio v i s u a l k i t s i n c l u d i n g tapes, s c r i p t s , and c o l o u r s l i d e s have been used in c o n t i n u i n g medical education but have not been found to be e f f e c t i v e (Nakamoto, 1973). Computer-assisted l e a r n i n g i s one of the most recent i n n o v a t i o n s i n d e l i v e r y systems. At present, i t i s more a p p r o p r i a t e f o r undergraduate t r a i n i n g than c o n t i n u i n g education because of the wide d i s t r i b u t i o n of l e a r n e r s . Summary of Related L i t e r a t u r e T h i s review of r e l a t e d l i t e r a t u r e supports the importance of c o n t i n u i n g education f o r competent p r a c t i s e i n o c c u p a t i o n a l therapy. The l i t e r a t u r e suggests that c o n s i d e r a t i o n of a number of v a r i a b l e s in the program plan n i n g process i s necessary to p r o v i d e r e l e v a n t and e f f e c t i v e programs f o r t h e r a p i s t s . The t h r e e v a r i a b l e s that were reviewed i n t h i s study were l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n , and d e l i v e r y systems. In r e l a t i o n to l e a r n i n g need, the importance of some form of assessment was empahasized and the two major approaches to assessment, f e l t and normative assessment, d i s c u s s e d . Although not c o n s i d e r e d as e s s e n t i a l a v a r i a b l e i n program planning as assessment, the n e c e s s i t y of i d e n t i f y i n g b a r r i e r s to 52 p a r t i c i p a t i o n was d e s c r i b e d . S i t u a t i o n a l and i n s t i t u t i o n a l b a r r i e r s to p a r t i c i p a t i o n were d e f i n e d and examples pr o v i d e d from the f i e l d of o c c u p a t i o n a l therapy. The t h i r d v a r i a b l e reviewed was systems of d e l i v e r i n g c o n t i n u i n g e d u c a t i o n . Using d i r e c t systems and d i s t a n c e systems as the major c a t e g o r i e s , the systems that are c u r r e n t l y used in the h e a l t h care f i e l d i n general were o u t l i n e d . The l i t e r a t u r e suggested that c e r t a i n c h a r a c t e r i s t i c s of p a r t i c i p a n t s i n c o n t i n u i n g education a f f e c t e d p e r c e p t i o n s of the needs and p r e f e r e n c e s i n programs. One of the c h a r a c t e r i s t i c s examined was the p r o f e s s i o n a l r o l e of the o c c u p a t i o n a l t h e r a p i s t . The review i n d i c a t e d that d i f f e r e n c e s in p e r c e p t i o n s e x i s t e d between s u p e r v i s o r s and t h e i r c l i n i c a l s t a f f . The geographic l o c a t i o n of the t h e r a p i s t was the second c h a r a c t e r i s t i c focussed on in r e l a t i o n to c o n t i n u i n g e d u c a t i o n . The l i t e r a t u r e r e v e a l e d that a d i s c r e p a n c y e x i s t s between o p p o r t u n i t y f o r continung education f o r r u r a l and urban p r a c t i t i o n e r s i n . t he h e a l t h care f i e l d . Although the m a j o r i t y of l i t e r a t u r e supported the need to i n c r e a s e the a v a i l a b i l i t y of programs for the r u r a l t h e r a p i s t s , there were few p r a c t i c a l examples of d e s c r i b i n g how to reduce p r o f e s s i o n a l i s o l a t i o n produced by geographic l o c a t i o n . 53 CHAPTER THREE METHOD Sett ing of Study At the time the study was conducted, c o n t i n u i n g education o p p o r t u n i t i e s i n B r i t i s h Columbia f o r o c c u p a t i o n a l t h e r a p i s t s were minimal. T h i s was l a r g e l y due to the absence of a D i r e c t o r of C o n t i n u i n g Education i n R e h a b i l i t a t i o n at the U n i v e r s i t y of B r i t i s h Columbia over the two years p r e v i o u s to the study P r i o r to . that time the D i r e c t o r had been r e s p o n s i b l e f o r planning and implementing the m a j o r i t y of programs in both physiotherapy and o c c u p a t i o n a l therapy. Although the s p e c i a l i n t e r e s t groups and p r o f e s s i o n a l o r g a n i z a t i o n s had o c c a s i o n a l l y o f f e r e d programs, these were not c o n s i s t e n t l y o f f e r e d nor was there an attempt to c o - o r d i n a t e these e f f o r t s . These programs tended to be one or two day workshops l o c a t e d i n the Greater Vancouver a r e a . The t y p i c a l program focussed on a c l i n i c a l s p e c i a l t y or treatment approach, u t i l i z i n g l o c a l experts as resource persons. The gen e r a l s e t t i n g f o r the study then, may be d e s c r i b e d as r i c h i n p o t e n t i a l f o r program plan n i n g i n c o n t i n u i n g e d u c a t i o n . 54 Design As one of the o b j e c t i v e s of the study was to i n v e s t i g a t e c h a r a c t e r i s t i c s of a p a r t i c u l a r p o p u l a t i o n i n r e l a t i o n to c o n t i n u i n g education, the resea r c h design used was a d e s c r i p t i v e survey. Normative statements r e g a r d i n g c o n t i n u i n g education in o c c u p a t i o n a l therapy were generated from the info r m a t i o n c o n t a i n e d on the q u e s t i o n n a i r e . The r e l a t i o n s h i p s hypothesized in the study were t e s t e d using a simple c o r r e l a t i o n a l design. Hypotheses Hypothesis 1 : There w i l l be a s i g n i f i c a n t d i f f e r e n c e in the percept ion of c l i n i c a l t h e r a p i s t s ' l e a r n i n g needs h e l d by c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s . One would expect that because of the g r e a t e r number of years i n the f i e l d of o c c u p a t i o n a l therapy, s u p e r v i s o r y t h e r a p i s t s would have d i f f e r e n t p e r c e p t i o n s of c o n t i n u i n g education than that of the c l i n i c a l t h e r a p i s t s they s u p e r v i s e . Although s u p e r v i s o r s t y p i c a l l y t r a v e l up the ranks from a c l i n i c a l p o s i t i o n to a more s e n i o r p o s i t i o n , s u p e r v i s o r s may co n s i d e r the needs of t h e i r s t a f f from a broader more experienced base with a long-term o r i e n t a t i o n while the c l i n i c a l t h e r a p i s t s may be more o r i e n t e d to p r a c t i c a l s k i l l s that are immediately r e l e v a n t . T h i s d i f f e r e n c e in p e r s p e c t i v e coupled with the s u p e r v i s o r ' s tendency to p r o j e c t t h e i r p e r c e p t i o n s on to s t a f f would suggest that d i f f e r e n c e s i n p e r c e p t i o n of 55 l e a r n i n g needs would e x i s t . Hypothesis 2: There w i l l be s i g n i f i c a n t d i f ferences in the ident i f i c a t ion of ba r r i e r s to p a r t i c i p a t ion between c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s . B a r r i e r s may be d e s c r i b e d as e i t h e r s i t u a t i o n a l , those r e l a t i n g to the i n d i v i d u a l ' s s i t u a t i o n at a given time or i n s t i t u t i o n a l , which r e l a t e to planning p r a c t i s e s which discourage p a r t i c i p a t i o n . Because of the longer involvement in the f i e l d of o c c u p a t i o n a l therapy and the p o t e n t i a l committment to c a r e e r , one c o u l d a n t i c i p a t e that s u p e r v i s o r y t h e r a p i s t s would more of t e n i d e n t i f y i n s t i t u t i o n a l b a r r i e r s than s i t u a t i o n a l ones. Because of the p r i o r i t y they would give t h e i r c a r e e r , s i t u a t i o n a l b a r r i e r s would be minimized to accommodate p r o f e s s i o n a l development. One would expect that s u p e r v i s o r y t h e r a p i s t s may c o n s i d e r t h e i r c l i n i c a l s t a f f to have the same committment to c o n t i n u i n g education and thus i d e n t i f y s i m i l a r b a r r i e r s to p a r t i c i p a t i o n . Hypothesis 3: There w i l l be a s i g n i f i c a n t d i f f e r e n c e i n the p e r c e p t i o n s of the d e l i v e r y systems p r e f e r r e d by c l i n i c a l t h e r a p i s t s h e l d by c l i n i c a l t h e r a p i s t s and supervi sory t h e r a p i s t s . D e l i v e r y systems can be c a t e g o r i z e d as e i t h e r d i r e c t systems, such as workshops or d i s t a n c e systems, such as e d u c a t i o n a l t e l e v i s i o n and r a d i o . Because s u p e r v i s o r y t h e r a p i s t s tend to be i n a p o s i t i o n where they are not committed to a r i g i d schedule of t r e a t i n g p a t i e n t s , one would expect they would be more able to attend the programs using d i r e c t d e l i v e r y systems 56 which are f i x e d in time and p l a c e . T h e i r s t a f f , however, are p r i m a r i l y i n v o l v e d with d i r e c t p a t i e n t care and thus l e s s f l e x i b l e i n terms of a t t e n d i n g programs using d i r e c t d e l i v e r y systems. Again, i t i s l i k e l y that the s u p e r v i s o r y t h e r a p i s t s would p r o j e c t t h e i r p e r c e p t i o n of p r e f e r r e d d e l i v e r y systems on to c l i n i c a l t h e r a p i s t s . Hypothesis 4: There w i l l be a s i g n i f i c a n t d i f f e r e n c e i n l e a r n ing needs ident i f i e d by r u r a l c l i n i c a l t h e r a p i s t s and urban c l i n i c a l t h e r a p i s t s . Because of the nature of h e a l t h care d e l i v e r y i n non- m e t r o p o l i t a n B r i t i s h Columbia, the r u r a l o c c u p a t i o n a l t h e r a p i s t i s o f t e n the only r e h a b i l i t a t i o n s p e c i a l i s t i n a r e g i o n . Rural t h e r a p i s t s f r e q u e n t l y have to c a r r y out a wide range of a c t i v i t i e s to meet the demands of the job. While r u r a l t h e r a p i s t s tend to be g e n e r a l i s t s , urban t h e r a p i s t s are t y p i c a l l y employed i n l a r g e i n s t i t u t i o n s with many t h e r a p i s t s and t h e r e f o r e are more s p e c i a l i z e d with fewer areas of c l i n i c a l competence r e l e v a n t to them. Hypothesis 5: Rural c l i n i c a l t h e r a p i s t s w i l l have a s i g n i f i c a n t l y higher est imate of l e a r n i n g need than do urban c l i n i c a l t h e r a p i s t s . R ural t h e r a p i s t s are f r e q u e n t l y s o l e charge s t a f f and because of t h e i r geographic remoteness have in f r e q u e n t c o n t a c t s with other t h e r a p i s t s and minimal o p p o r t u n i t y to p a r t i c i p a t e i n c o n t i n u i n g education programs. Because of t h i s i s o l a t i o n , one would expect r u r a l t h e r a p i s t s to r e q u i r e updating of s k i l l s and knowledge more than t h e i r urban c o l l e a g u e s who have e a s i e r 57 access to c o n t i n u i n g education programs and information exchange. Hypothesis 6: There w i l l be a s i g n i f i c a n t d i f f e r e n c e i n barr i e r s to p a r t i c i p a t i o n ident i f i e d by r u r a l c l i n i c a l t h e r a p i s t s and urban c l i n i c a l t h e r a p i s t s . Because of the geographic i s o l a t i o n , one would expect that r u r a l t h e r a p i s t s would more o f t e n i d e n t i f y t r a n s p o r t a t i o n and d i s t a n c e as b a r r i e r s to p a r t i c i p a t i o n while urban t h e r a p i s t s would i n d i c a t e i n s t i t u t i o n a l b a r r i e r s such as scheduling or inadequate n o t i c e . Hypothesis 7: There w i l l be a s i g n i f i c a n t d i f ference i n d e l i v e r y systems p r e f e r r e d by r u r a l c l i n i c a l t h e r a p i s t s and urban c l i n i c a l t h e r a p i s t s . Because of the tendency f o r the c o n t i n u i n g education programs to be l o c a t e d i n Vancouver and V i c t o r i a , one would expect that r u r a l t h e r a p i s t s would have d i f f i c u l t y a t t e n d i n g c o n t i n u i n g education programs. As a r e s u l t of these geographic b a r r i e r s , one would a n t i c i p a t e that r u r a l t h e r a p i s t s would p r e f e r d i s t a n c e d e l i v e r y systems more than urban who have e a s i e r access to a grea t e r number of d i r e c t d e l i v e r y programs. Sample The p o p u l a t i o n s t u d i e d i n c l u d e d a l l q u a l i f i e d o c c u p a t i o n a l t h e r a p i s t s p r a c t i s i n g f u l l time or part time i n B r i t i s h Columbia. The sample c o n s i s t e d of 295 t h e r a p i s t s . Sample s e l e c t i o n was based upon the respondent's being an a c t i v e member 58 of the B r i t i s h Columbia S o c i e t y of Occupat i o n a l T h e r a p i s t s (B.C.S.O.T.) as of December 1, 1981. P r i o r to d i s t r i b u t i n g the q u e s t i o n n a i r e , a n o t i c e was p l a c e d i n the B.C.S.O.T. newsletter s t a t i n g that the membership l i s t was being made a v a i l a b l e to the i n v e s t i g a t o r f o r purposes of t h i s study. I n d i v i d u a l s who d i d not want t h e i r name r e l e a s e d were given one month to n o t i f y the S o c i e t y of t h i s f a c t . Only one i n d i v i d u a l d i d so and was excluded from the study sample. In a d d i t i o n , the ten t h e r a p i s t s who p a r t i c i p a t e d in the p i l o t t e s t of the data gathering instrument were excluded from the sample. The sample was grouped a c c o r d i n g to p r o f e s s i o n a l r o l e , c l i n i c i a n s and s u p e r v i s o r s , i n order to examine the f i r s t set of hypotheses. I t was then recombined i n t o r u r a l and urban subgoups to t e s t the second set of hypotheses d e a l i n g with geographic l o c a t i o n . The c r i t e r i a used to d e f i n e these subgroups w i l l be d e s c r i b e d in the in s t r u m e n t a t i o n s e c t i o n . These samples were not subd i v i d e d f u r t h e r by combining geographic and r o l e d e f i n i t i o n s because of the l i m i t e d number of s u p e r v i s o r s in the r u r a l areas. As p r e v i o u s l y s t a t e d , the m a j o r i t y of r u r a l t h e r a p i s t s work i n i s o l a t i o n and thus the c l i n i c a l and s u p e r v i s o r y c a t e g o r i e s can not be a p p l i e d i n the case of r u r a l h e a l t h care d e l i v e r y . The sample was h i g h l y r e p r e s e n t i t i v e of the p o p u l a t i o n s t u d i e d , o c c u p a t i o n a l t h e r a p i s t s i n B r i t i s h Columbia. Stan (Note 8) estimates that 85% of a l l t h e r a p i s t s in the p r o v i n c e belong to the B.C.S.O.T. and t h e r e f o r e are i n c l u d e d i n the sample. Although no attempt was made to represent t h e r a p i s t s i n Canada, because of the s i m i l a r i t i e s i n work s e t t i n g s , p r o f e s s i o n a l t r a i n i n g , and h e a l t h care d e l i v e r y systems, t h i s study has 59 i m p l i c a t i o n s for Canadian t h e r a p i s t s in g e n e r a l . Data C o l l e c t i o n Instrumentat ion The q u e s t i o n n a i r e (Appendix A) was developed s p e c i f i c a l l y f o r t h i s study of c o n t i n u i n g education f o r o c c u p a t i o n a l t h e r a p i s t s i n B r i t i s h Columbia. Although a number of other survey q u e s t i o n n a i r e s were reviewed in the c o n s t r u c t i o n of the items in t h i s q u e s t i o n n a i r e , none of the items had been used p r e v i o u s l y . The q u e s t i o n n n a i r e i s d i v i d e d i n t o three s e c t i o n s . The f i r s t s e c t i o n focuses on the d e f i n i t i o n of the respondent i n r e l a t i o n to geographic l o c a t i o n and f u n c t i o n a l r o l e . Based on the d e f i n i t i o n of r o l e as e i t h e r c l i n i c a l t h e r a p i s t or s u p e r v i s o r y t h e r a p i s t in the f i r s t s e c t i o n , the remainder of the q u e s t i o n n a i r e was completed d i f f e r e n t l y by the two subsamples. C l i n i c a l t h e r a p i s t s completed the items as they p e r t a i n e d to the respondent as a c l i n i c i a n , s u p e r v i s i n g t h e r a p i s t s responded i n r e l a t i o n to what they c o n s i d e r e d t h e i r s t a f f ' s needs and p r e f e r e n c e s to be. The second s e c t i o n of the q u e s t i o n n a i r e i d e n t i f i e s p e r c e i v e d b a r r i e r s to p a r t i c i p a t i o n in c o n t i n u i n g education and p r e f e r e n c e s of d e l i v e r y systems. The t h i r d s e c t i o n r e p r e s e n t s a l e a r n i n g needs assessment. 60 Sect ion I_ The f i r s t item i n the q u e s t i o n n a i r e d e f i n e s the respondent's geographic l o c a t i o n . T h i s r e l a t e s to the research q u e s t i o n s examining d i f f e r e n c e s between urban and r u r a l t h e r a p i s t s . In t h i s study, urban i s d e f i n e d as e i t h e r Vancouver or the Lower Mainland and V i c t o r i a and r u r a l as any l o c a t i o n other than these two. T h i s d e f i n i t i o n i s based on the low c o n c e n t r a t i o n of o c c u p a t i o n a l t h e r a p i s t s i n any s i n g l e l o c a t i o n o u t s i d e of Vancouver and V i c t o r i a . Although a number of respondents r e s i d e in small c i t i e s elsewhere in B.C., these can not be co n s i d e r e d as urban because of lack of c o n t i n u i n g p r o f e s s i o n a l education o p p o r t u n i t i e s that c h a r a c t e r i z e the l a r g e r c e n t e r s such as i n t e r - h o s p i t a l education programs, s p e c i a l i n t e r e s t groups, use of u n i v e r s i t y resources, and l i b r a r y f a c i l i t i e s . The seven geographic d i s t r i c t s used i n the q u e s t i o n n a i r e are those that the B.C.S.O.T. bases t h e i r membership d i s t r i b u t i o n upon. I t was assumed that the respondent would recognize the a p p r o p r i a t e d i s t r i c t i n Item 1 because of t h e i r f a m i l i a r i t y with these c a t e g o r i e s being members of B.C.S.O.T. In a d d i t i o n , t h i s item p r o v i d e s i n f o r m a t i o n on the geographic d i s t r i b u t i o n of t h e r a p i s t s which has i m p l i c a t i o n s f o r p r o v i d i n g non-metropolitan programs to those r u r a l t h e r a p i s t s . The second item on the q u e s t i o n n a i r e , o p p o r t u n i t y to d i s c u s s p r o f e s s i o n a l problems and i s s u e s , i s designed to assess the p r o p o s i t i o n that geographic d i f f e r e n c e s may be p a r t i a l l y e x p l a i n e d by d i f f e r e n c e s i n the frequency of p r o f e s s i o n a l c o n t a c t . D e f i n i t i o n of the respondent as e i t h e r a c l i n i c a l t h e r a p i s t 61 or a s u p e r v i s i n g t h e r a p i s t i s undertaken in items 3-5. The d e f i n i t i o n occurs in three steps to ensure that the respondent's d e f i n i t i o n of these terms match the ones set out i n the study. S p e c i f i c a t i o n of job t i t l e i s the f i r s t l e v e l of d e f i n i t i o n . The c h o i c e s l i s t e d are d e r i v e d from the manpower s t u d i e s on the p r o f e s s i o n of o c c u p a t i o n a l therapy. The f i r s t three job t i t l e s w i l l be c o n s i d e r e d in the c l i n i c a l t h e r a p i s t category and the remaining ones in the s u p e r v i s i n g t h e r a p i s t category. The second l e v e l of d e f i n i t i o n asks the t h e r a p i s t to assess t h e i r f u n c t i o n a l r o l e i n r e l a t i o n to the two c a t e g o r i e s and i d e n t i f y which one they f u n c t i o n in most f r e q u e n t l y . The t h i r d l e v e l of d e f i n i t i o n uses the number of t h e r a p i s t s under the respondent's d i r e c t i o n as a means of d i s t i n g u i s h i n g the groups. T h i s item i s based on the assumption that c l i n i c a l t h e r a p i s t s w i l l respond 0 and s u p e r v i s i n g t h e r a p i s t s w i l l respond 1 or more. In order f o r a q u e s t i o n n a i r e to be c o n s i d e r e d v a l i d i n t h i s study, a l l three d e f i n i t i o n s must i d e n t i f y the t h e r a p i s t i n the same catagory. Those that d i d not meet t h i s c r i t e r i o n were excluded from the sample. Item 5, asking the number of t h e r a p i s t s under the respondent's d i r e c t i o n was a l s o used to examine the e f f e c t of d i f f e r e n c e s i n a s u p e r v i s i n g t h e r a p i s t ' s s t a f f s i z e to t h e i r p e r c e p t i o n of c l i n i c i a n s needs and p r e f e r e n c e s i n . c o n t i n u i n g e d u c a t i o n . Item 6, extent of p r o f e s s i o n a l experience in o c c u p a t i o n a l therapy, was used to assess the r e l a t i o n s h i p between years of experience and f u n c t i o n a l r o l e i n r e l a t i o n to e x p l a i n i n g d i f f e r e n c e s i n p e r c e p t i o n of needs and p r e f e r e n c e s between c l i n i c a l t h e r a p i s t s and s u p e r v i s i n g t h e r a p i s t s . 62 Sect ion 11 The reasons why t h e r a p i s t s do not a t t e n d c o n t i n u i n g education programs were i d e n t i f i e d i n Item 1. Smorynski and Panocha (1979) s t a t e that one of the major l i m i t a t i o n s of most needs surveys i n c o n t i n u i n g education i s the f a i l u r e to i d e n t i f y f a c t o r s which l i m i t p a r t i c i p a t i o n . They s t a t e that although a high i n t e r e s t or need may e x i s t , the b a r r i e r s to p a r t i c i p a t i o n may outweigh i n t e n t i o n . By i d e n t i f y i n g reasons f o r non- p a r t i c i p a t i o n , the planner i s p rovided with those f a c t o r s i n the program plan n i n g process that c o u l d be manipulated in order to i n c r e a s e p a r t i c i p a t i o n . The b a r r i e r s i n c l u d e d in t h i s study are based on s t u d i e s in p a r t i c i p a t i o n in c o n t i n u i n g p r o f e s s i o n a l e d u c a t i o n , the m a j o r i t y of which are found in the h e a l t h care l i t e r a t u r e . These b a r r i e r s can be c a t e g o r i z e d as e i t h e r i n s t i t u t i o n a l or d i s p o s i t i o n a l i n nature (Cross, 1980). T h i s d i s t i n c t i o n was used in a s s e s s i n g d i f f e r e n c e s among the four subgroups i d e n t i f i e d i n the study, c l i n i c a l t h e r a p i s t s , s u p e r v i s i n g t h e r a p i s t s , r u r a l t h e r a p i s t s and urban t h e r a p i s t s . I t should be noted that Cross i d e n t i f i e s a t h i r d type of b a r r i e r in her t ypology. D i s p o s i t i o n a l b a r r i e r s are r e l a t e d to a t t i t u d e s and s e l f - p e r c e p t i o n about the s e l f as a l e a r n e r . B a r r i e r s of t h i s type were excluded from study because the review of l i t e r a t u r e r e v e a l e d that they are seldom expressed as b a r r i e r s i n s t u d i e s using a s e l f - r e p o r t d e s i g n . P r e f e r r e d d e l i v e r y systems was the second program plan n i n g v a r i a b l e c o n s i d e r e d in the q u e s t i o n n a i r e . The e i g h t a l t e r n a t i v e s in Item .2 were d e r i v e d from the most commonly c i t e d systems i n the l i t e r a t u r e reviewed with c o n s i d e r a t i o n f o r the resources 63 that are a v a i l a b l e to o c c u p a t i o n a l t h e r a p i s t s in B.C. at the present time. The item i s based on the d i s t i n c t i o n between d i s t a n c e d e l i v e r y systems and non-distance systems which w i l l be used s p e c i f i c a l l y in the i d e n t i f i c a t i o n of d i f f e r e n c e s between urban and r u r a l t h e r a p i s t s . Because of the s p e c i a l circumstances in B r i t i s h Columbia where s a t e l l i t e e d u c a t i o n a l t e l e v i s i o n has become a v a i l a b l e f o r use i n c o n t i n u i n g p r o f e s s i o n a l education by the h e a l t h p r o f e s s i o n s , an item d e a l i n g s p e c i f i c a l l y with t h i s d e l i v e r y system was i n c l u d e d . The importance of o b t a i n i n g more d e t a i l e d i n f o r m a t i o n about t h i s d e l i v e r y system in r e l a t i o n to the p r a c t i s e of program plan n i n g outweighs the p o t e n t i a l l y negative e f f e c t that f o c u s s i n g on a s i n g l e c h o i c e may have i n b i a s i n g the respondents answer to Item 2. Sect ion III The t h i r d s e c t i o n of the q u e s t i o n n a i r e i s designed to assess the l e a r n i n g needs of c l i n i c a l t h e r a p i s t s i n o c c u p a t i o n a l therapy. Nowlen(l980) d e s c r i b e s a number of important f a c t o r s i n the development of a needs assessment that were co n s i d e r e d i n the c o n s t r u c t i o n of t h i s instrument. He s t a t e s that i n order f o r the assessment to be v a l i d , the f o l l o w i n g i s s u e s must be addressed: what are the s p e c i f i c performance standards of the p r o f e s s i o n being assessed? To what extent does the p o t e n t i a l p a r t i c i p a n t measure up to t h i s standard? Is there a gap to be c l o s e d by an e d u c a t i o n a l a c t i v i t y ? These three p o i n t s are the b a s i s upon which a t o o l using competency statements and e v a l u a t i o n of the respondents' e x p e r t i s e i n these areas was developed. 64 The use of competency statements to i d e n t i f y areas where an e d u c a t i o n a l need e x i s t s i s the most d i r e c t manner of i n c o r p o r a t i n g standards of p r o f e s s i o n a l p r a c t i s e i n t o an assessment t o o l . Competencies d e s c r i b e s i g n i f i c a n t , s k i l l f u l l y performed, work-related a c t i v i t e s that make up the p r a c t i s e of a p r o f e s s i o n (American Physiotherapy A s s o c i a t i o n , 1973). The use of competency statements in education has been p r i m a r i l y i n the areas of d e f i n i n g and e v a l u a t i n g the important t h i n g s that a student must know i n order to f u n c t i o n competently as an entr y - l e v e l t h e r a p i s t . Although the f i e l d of c o n t i n u i n g education has been d e s c r i b e d as one of the most robust and promising areas of a p p l i c a t i o n of competency a n a l y s i s , the l i t e r a t u r e r e v e a l s no attempt to apply the concept (Canadian A s s o c i a t i o n of Occu p a t i o n a l Therapy, 1980). The use of competency statements decreases many of the problems a s s o c i a t e d with needs assessment in a f i e l d where the areas of s p e c i a l i z a t i o n are numerous and work s e t t i n g s d i v e r s e . Because o c c u p a t i o n a l therapy i s so broadly d e f i n e d and the r o l e s of the t h e r a p i s t s c o n t i n u a l l y expanding, d e f i n i n g p o t e n t i a l areas of need upon which to base c o n t i n u i n g education programs i s d i f f i c u l t . A review of the l i t e r a t u r e r e v e a l s that the m a j o r i t y of t o o l s that have been used i n the past use eit h e r ' c l i n i c a l c o n d i t i o n s or t h e r a p e u t i c techniques as the b a s i s of a needs assessment. These t o o l s have tended to be i n c o n c l u s i v e and t y p i c a l l y biased to one area of s p e c i a l i z a t i o n . The use of competency statements can minimize these problems. Because the purpose of developing competency statements i n o c c u p a t i o n a l therapy was to d e s c r i b e the p r o f e s s i o n as a s i n g l e e n t i t y r a t h e r than m u l t i p l e areas of 65 p r a c t i s e , the statements are r e p r e s e n t a t i v e of more t h e r a p i s t s ' s i t u a t i o n s than c l i n i c a l s p e c i a l t y areas. The competencies i n c l u d e d in t h i s q u e s t i o n n a i r e are a s y n t h e s i s of those o f f i c i a l l y adopted by the Canadian A s s o c i a t i o n of Oc c u p a t i o n a l Therapy and the American Occupa t i o n a l Therapy A s s o c i a t i o n . Of the 136 competencies r e q u i r e d of an e n t r y - l e v e l t h e r a p i s t , only 30 were used i n t h i s assessment t o o l . These items were chosen because of t h e i r r elevance to the c l i n i c a l t h e r a p i s t r e s p o n s i b l e f o r d i r e c t p a t i e n t c a r e . Other competencies that were r e l e v a n t to the management, education, and a d m i n i s t r a t i v e r o l e s of the t h e r a p i s t were omitted as not p e r t i n e n t to the p o p u l a t i o n i n v e s t i g a t e d . The second component of the needs assessment, the s c a l e on which the need i s estimated, i s based on the comparison to a standard and i d e n t i f i c a t i o n of a gap. For each of the competency statements l i s t e d , the respondent was asked to i d e n t i f y the e x i s t i n g l e v e l and d e s i r e d l e v e l of e x p e r t i s e i n the competency area. The d i f f e r e n c e between these i n d i c a t e s that a need i s present that c o u l d be addressed by an e d u c a t i o n a l program. The importance of basing the q u e s t i o n n a i r e on a d i s c r e p a n c y or need i s emphasized by Knowles (1970) when he d i s t i n g u i s h e d between i n t e r e s t surveys and need surveys. He s t a t e s that e d u c a t i o n a l i n t e r e s t s are expressions of pre f e r e n c e s among a l t e r n a t i v e a c t i v i t i e s whereas needs are a comparison between two s t a t e s . A review of the l i t e r a t u r e of needs assessment i n the h e a l t h care f i e l d r e v e a l s that the m a j o r i t y of t o o l s were a check l i s t i n v e n t o r y s t y l e and were measuring e d u c a t i o n a l i n t e r e s t r a t h e r than need (Bros k i & Upps, 1979; Hightower, 1973; McGregor, Note 66 5 ) . Smorynski & Panocha (1979) q u e s t i o n whether sampling a p o p u l a t i o n u s i n g an i n t e r e s t survey method i s an adequate measure of program demand but make no recommendations on the c o n s t r u c t i o n of a more a p p r o p r i a t e needs assessment t o o l . The assessment t o o l i n t h i s study d e f i n e s the gap or d i s c r e p a n c y i n d i c a t i n g need by h a v i n g the respondent i n d i c a t e t h e i r e x i s t i n g and d e s i r e d l e v e l o f , e x p e r t i s e i n a competency a r e a on a t h r e e p o i n t s c a l e . By s u b t r a c t i n g the v a l u e a s s i g n e d t o the e x i s t i n g l e v e l of competence from the d e s i r e d l e v e l , an e s t i m a t e of need can be s t a t e d . In a d d i t i o n t o the i d e n t i f i c a t i o n of a need, an e s t i m a t e of the r e l e v a n c e of each competency statement t o the r o l e of the c l i n i c a l t h e r a p i s t i s i n d i c a t e d on a t h r e e p o i n t s c a l e . Based on the d i v e r s e n a t u r e of o c c u p a t i o n a l t h e r a p y p r a c t i s e , i t i s l o g i c a l t o assume t h a t importance of each of the competencies would v a r y w i t h i n the sample. In terms of program p l a n n i n g , i f two competencies are a s s i g n e d the same need e s t i m a t e , r a n k i n g the needs becomes a problem. If," however, t h e r e i s an e s t i m a t e of importance of each need, and these v a r y , the p l a n n e r i s p r o v i d e d w i t h more d i r e c t i o n i n r e l a t i o n t o p l a n n i n g e d u c a t i o n a l programs. The f o u r t h c a t e g o r y of the needs assessment s c a l e was a l s o d e s i g n e d t o g i v e the program p l a n n e r more s p e c i f i c d i r e c t i o n . I d e n t i f y i n g whether t r a i n i n g i s a v a i l a b l e i n each competency a r e a at p r e s e n t h e l p s t o m i n i m i z e redundancy i n programs. Even though a need e x i s t s which i s r e l e v a n t t o the t h e r a p i s t , t h i s does not p r e c l u d e the f a c t t h a t programs a r e a l r e a d y a v a i l a b l e and t h a t the respondent has not taken advantage of them f o r any number of r e a s o n s . Another p o s s i b l e 6 7 s i t u a t i o n that may e x i s t i s that although the programs are a v a i l a b l e they are not s u c c e s s f u l or are not s u f f i c e n t l y r e l e v e n t to the p r a c t i s e of o c c u p a t i o n a l therapy. The number of agencies that are c u r r e n t l y i n v o l v e d i n o f f e r i n g c o n t i n u i n g education programs i n the h e a l t h care area support the i n c l u s i o n of t h i s i n f o r m a t i o n in a needs assessment. P i l o t Test of Instrument In order to c l a r i f y the wording'of the q u e s t i o n n a i r e items and reduce the e r r o r of i n t e r p r e t a i o n , the q u e s t i o n n a i r e was p r e - t e s t e d by 10 t h e r a p i s t s not in c l u d e d i n the study sample. Minor changes i n the wording in the i n s t r u c t i o n s i n S e c t i o n II were made in response to t h i s t e s t . Because the competency statements used in the l e a r n i n g needs assessment were taken d i r e c t l y from a composite l i s t approved by the Canadian and American A s s o c i a t i o n of Occ u p a t i o n a l Therapy, no attempt was made to determine the v a l i d i t y of the statements as requirements of entry l e v e l o c c u p a t i o n a l t h e r a p i s t s . The p i l o t group d i d assess the competencies i n r e l a t i o n to t h e i r relevance to the c l i n i c a l t h e r a p i s t . One competency i n c l u d e d on the o r i g i n a l q u e s t i o n n a i r e was d e l e t e d because i t was unclear i f i t p e r t a i n e d more o f t e n to the a d m i n i s t r a t i v e r o l e of the t h e r a p i s t r a t h e r than the c l i n i c a l r o l e . 68 Procedures The c o - o p e r a t i o n of the D i v i s o n of C o n t i n u i n g Education i n the Health Sciences and the B.C.S.O.T. was e n l i s t e d p r i o r to undertaking t h i s study. A p e r s o n a l v i s i t was made to r e p r e s e n t i t i v e s of both agencies to e x p l a i n the purposes and i m p l i c a t i o n s of the study. A l e t t e r of support was obtained from the B.C.S.O.T. at that time to be i n c l u d e d with the q u e s t i o n n a i r e in an attempt to maximize response r a t e (Appendix C). - In a d d i t i o n , the membership l i s t was p r o v i d e d by the B.C.S.O.T. which became the b a s i s of the sample. The l i s t was coded in order to i d e n t i f y non-respondents fo r follow-up purposes. The q u e s t i o n n a i r e was d i s t r i b u t e d with a c o v e r i n g l e t t e r (Appendix B) and the l e t t e r of support to a l l names on the membership l i s t . In a d d i t i o n , a schedule of c o n t i n u i n g education o p p o r t u n i t i e s f o r the f o l l o w i n g four months and a promotional pamphlet for an upcoming program were i n c l u d e d i n the m a i l i n g . These items were i n c l u d e d f o r two reasons. F i r s t l y , because c o n t i n u i n g education had experienced such a low p r o f i l e i n the f i e l d of o c c u p a t i o n a l therapy i n the past few years, some evidence was needed to i l l u s t r a t e that there was some planning a c t i v i t y o c c u r i n g and that the survey i n f o r m a t i o n would be used i n these a c t i v i t i e s . The second reason f o r i n c l u d i n g a d d i t i o n a l m a t e r i a l s with the q u e s t i o n n a i r e was that o f t e n by p r o v i d i n g something of value or p o t e n t i a l value to the i n d i v i d u a l s i n the sample, response r a t e may be i n c r e a s e d (Payton, 1979). Four weeks were allowed before a second m a i l i n g of the q u e s t i o n n a i r e to non-respondents' was conducted. A c o v e r i n g 69 l e t t e r (Appendix B) and another copy of the q u e s t i o n n a i r e was mailed to i n d i v i d u a l s who had not responded by the d e a d l i n e s p e c i f i e d i n the o r i g i n a l l e t t e r . N o t i c e s were sent to the s p e c i a l i n t e r e s t groups, s u p e r v i s o r ' s group, and p r o f e s s i o n a l n e w s l e t t e r s r e i t e r a t i n g the importance of the study and reminding t h e r a p i s t s to r e t u r n t h e i r q u e s t i o n n a i r e s . Data A n a l y s i s The data from the q u e s t i o n n a i r e f e l l i n t o four d i f f e r e n t c a t e g o r i e s : b i o g r a p h i c data, p e r c e i v e d b a r r i e r s to p a r t i c i p a t i o n , p r e f e r r e d d e l i v e r y systems and l e a r n i n g needs. The q u e s t i o n n a i r e s were coded and the data was t r a n s f e r r e d to a computer d i s c and analyzed using U.B.C.'s v e r s i o n of SPSS, the S t a t i s t i c a l Package f o r the S o c i a l S c i e n c e s . Summary s t a t i s t i c s using the frequency r o u t i n e were d e r i v e d from the b i o g r a p h i c data which i n c l u d e d frequency of response on the f o l l o w i n g v a r i a b l e s : geographic l o c a t i o n , job t i t l e , r o l e , number of s t a f f under the respondent's d i r e c t i o n , and years of experience. Measures of a s s o c i a t i o n i n c l u d i n g Chi Square, K e n d a l l ' s Tau, and T - t e s t s were then a p p l i e d to the four sample subgroups to t e s t the hypothesized r e l a t i o n s h i p s between r u r a l and urban t h e r a p i s t s and s u p e r v i s o r y and c l i n i c a l t h e r a p i s t s in r e l a t i o n to the three program v a r i a b l e s . The m u l t i p l e T - t e s t r o u t i n e was used to a v o i d the c a l c u l a t i o n by chance of s i g n i f i c a n t r e l a t i o n s h i p s because of the number of t e s t s that were conducted. In order that a s i n g l e estimate of need be e s t a b l i s h e d , a value f o r each competency was c a l c u l a t e d by 70 s u b t r a c t i n g the value assigned to e x i s t i n g need from the value assigned to d e s i r e d need and m u l t i p l y i n g t h i s value by the value assigned to the relevance of the competency to the t h e r a p i s t . The p o t e n t i a l need estimate c o u l d range from 0, i n d i c a t i n g an absence of need to 6, i n d i c a t i n g a s i g n i f i c a n t need. 71 CHAPTER FOUR RESULTS T h i s chapter presents the f i n d i n g s of the study based on the a n a l y s i s of the data c o l l e c t e d using the survey instrument presented i n Chapter Three. The r e s u l t s d e s c r i b i n g the r e l e v a n t c h a r a c t e r i s t i c s of the sample w i l l be presented f i r s t f o l l o w ed by the f i n d i n g s a s s o c i a t e d with the f o l l o w i n g r e l a t i o n s h i p s : 1) l e a r n i n g needs and p r o f e s s i o n a l r o l e 2) l e a r n i n g needs and geographic l o c a t i o n 3) p e r c e i v e d b a r r i e r s to p a r t i c i p a t i o n and p r o f e s s i o n a l r o l e 4) p e r c e i v e d b a r r i e r s to p a r t i c i p a t i o n and geographic l o c a t ion 5) p r e f e r r e d d e l i v e r y systems and p r o f e s s i o n a l r o l e 6) p r e f e r r e d d e l i v e r y systems and geographic l o c a t i o n In a d d i t i o n , a number of r e l a t i o n s h i p s not f o r m a l l y p o s t u l a t e d w i l l be presented as r e l e v a n t to the study. Response Rate The response rate in t h i s study was measured by the percentage of mailed q u e s t i o n n a i r e s returned by the predetermined c u t o f f date s i x weeks a f t e r the f i r s t m a i l i n g . Of the t o t a l sample (285), 182^questionnaires were return e d , 176 of 72 them usable. C a l c u l a t i n g the response rate based on t o t a l r e t u r n y i e l d s a 63.85% response r a t e . If the s i x q u e s t i o n n a i r e s excluded from the sample because they d i d not meet the c r i t e r i a of p r o f e s s i o n a l r o l e d e f i n i t i o n are not i n c l u d e d , the response rate i s 61.75%. T h i s i s an a c c e p t a b l e response rate a c c o r d i n g to Payton (1979) and C u r r i e r (1980) who estimate that between 40%- 60% i s the average rate f o r mailed q u e s t i o n n a i r e s of t h i s nature. There are, however, a number of f a c t o r s which may have i n f l u e n c e d the response rate in t h i s p a r t i c u l a r study. The f a c t that the m a i l i n g was c a r r i e d out d u r i n g the month of December co u l d have decreased the response r a t e . The mail o v e r l o a d at that time of year p l u s the f a c t that many i n d i v i d u a l ' s take h o l i d a y s may have reduced the response to the study. A second f a c t o r i s that the address l i s t used to mail q u e s t i o n n a i r e s was somewhat out of date as i n d i c a t e d by the 19 q u e s t i o n n a i r e s which were returned u n d e l i v e r e d . A small number of q u e s t i o n n a i r e s were returned bearing the comment that t h i s was only one of many surveys that they had been sent i n recent months and that i t was becoming a very time consuming and f r u s t r a t i n g e x e r c i s e . Although these three respondents completed the q u e s t i o n n a i r e , others i n the sample may have had s i m i l a r experiences and simply d i s r e g a r d e d the q u e s t i o n n a i r e . C h a r a c t e r i s t i c s of Respondents Because the problem which t h i s study i n v e s t i g a t e d was r e l a t i v e l y w e l l focussed and the v a r i a b l e s c l e a r l y d e l i n e a t e d , minimal general demographic data was s o l i c i t e d . Common v a r i a b l e s 73 such as age, e d u c a t i o n a l background, and sex were not assessed because o c c u p a t i o n a l t h e r a p i s t s may be c o n s i d e r e d s u f f i c e n t l y homogeneous in r e l a t i o n to these v a r i a b l e s f o r the purposes of t h i s study. The d e s c r i p t i v e data tapped in t h i s study were as f o l l o w s : p r o f e s s i o n a l r o l e and t i t l e , geographic l o c a t i o n , number of year-s - experience, and o p p o r t u n i t y for p r o f e s s i o n a l c o n t a c t . P r o f e s s i o n a l Role Of the 176 respondents, 139 (79%) were c l i n i c a l t h e r a p i s t s and 37 (21%) s u p e r v i s o r y t h e r a p i s t s a c c o r d i n g to the d e f i n i t i o n Used in t h i s study. T h i s r e s u l t i s c o n s i s t a n t with f i n d i n g s i n other s t u d i e s i n v e s t i g a t i n g p r o f e s s i o n a l r o l e using s i m i l a r methods (Chatham, 1980; P r i c e , 1967). The respondent's job t i t l e was s o l i c i t e d as a method for c l a s s i f y i n g respondents as c l i n i c i a n s or s u p e r v i s o r s . Table 1 r e p r e s e n t s the d i s t r i b u t i o n of the sample ac c o r d i n g to job t i t l e . The r e s u l t s support the l i t e r a t u r e d e s c r i b i n g r e h a b i l i t a t i o n as a f i e l d with two d i s t i n c t job c a t e g o r i e s , s t a f f and a d m i n i s t r a t o n . In t h i s sample, only one respondent was c l a s s i f i e d as an a s s i s t a n t s u p e r v i s o r and 26 as s e n i o r t h e r a p i s t s . In a d d i t i o n , there was only one c o n s u l t a n t among the sample, an unexpected f i n d i n g c o n s i d e r i n g the growth of such p o s i t i o n s i n other a l l i e d h e a l t h prof e s s i o n s . T r a d i t i o n a l l y t h e r e have been few graded s c a l e s of advancement i n the f i e l d of o c c u p a t i o n a l therapy; the data on s i z e of s t a f f , i n d i c a t i n g department s i z e , suggest that departments are s m a l l , a s i t u a t i o n which does not e a s i l y lend i t s e l f to a broad range of l e v e l s of Table 1 Distribution of Occupational Therapists by Job Title Job Title Number of Responses Adjusted % Sample Urban Rural Total Urban Rural Total Staff therapists 76 14 92 45.9 8.2 54.1 Senior therapist 20 6 26 11.8 3.5 15.3 Sole charge 10 13 21 5.9 6.5 12.4 Assistant supervisor 1 0 1 0.6 0.0 0.6 Supervisor 21 4 19 8.8 2.4 11.2 Program Co-ordinator/ Director 4 3 7 2.4 l . a 4.1 Instructor/Professor/ Lecturer 3 0 3 1.8 0.0 1.8 Consultant 1 0 1 0.6 0.0 0.6 Total 136 40 176 77.3 22.7 100.0 — J It* 75 r e s p o n s i b i 1 i t y . S t a f f S i z e The s i z e of the departments which the s u p e r v i s o r s managed was assessed i n the item asking the number of t h e r a p i s t s under the respondent's d i r e c t i o n . The d i s t r i b u t i o n i s represented i n Table 2. An assumption u n d e r l y i n g t h i s item was that the c l i n i c a l t h e r a p i s t s would respond zero while the s u p e r v i s o r y t h e r a p i s t s would choose one of the other c a t e g o r i e s . The r e s u l t s i n d i c a t e that i n s i x cases, c l i n i c a l t h e r a p i s t s s u p e r v i s e d other s t a f f . It i s p o s s i b l e that these numbers may i n d i c a t e s u p e r v i s i o n of n o n - p r o f e s s i o n a l s t a f f , a very common s i t u a t i o n in the f i e l d of r e h a b i l i t a t i o n . Another p o s s i b l e e x p l a n a t i o n i s that the i n d i v i d u a l , although t e c h n i c a l l y r e s p o n s i b l e f o r a number of t h e r a p i s t s , spent a minimum amount of time i n an a d m i n i s t r a t i v e or s u p e r v i s o r y r o l e and t h e r e f o r e i d e n t i f i e d t h e i r r o l e f o r the purposes of t h i s study as a c l i n i c a l t h e r a p i s t . Because these cases c o u l d not be c l a s s e d as e i t h e r c l i n i c i a n or s u p e r v i s o r a c c o r d i n g to the d e f i n t i o n s adopted f o r t h i s study, they were excluded from the sample. In r e l a t i o n to the d i s t r i b u t i o n of s t a f f s i z e , as i n d i c a t e d above, the most common response was a department of f i v e or fewer t h e r a p i s t s , 92.3% of the sample responded i n that category. The small s i z e s of the s u p e r v i s i n g t h e r a p i s t s ' s t a f f s has i m p l i c a t i o n s i n r e l a t i o n to how we l l the s u p e r v i s o r s know t h e i r s t a f f and the opp o r t u n i t y f o r them to assess the needs and pr e f e r e n c e s of the s t a f f on a continuous b a s i s . C o n s i d e r i n g the d i s t r i b u t i o n i n r e l a t i o n to geographic Table 2 Number of Occupational Therapists Under Respondent's Direction Staff Size Number of Responses Adjusted % Sample Urban Rural Total Urban Rural Total 0 therapists 99 34 133 58.2 20.0 78.2 1-5 therapists 20 4 24 11.8 2.4 14.1 6-10 therapists 6 1 7 3.5 0.6 4.1 11-15 therapists 3 0 3 1.8 0 1.8 More than 16 therapists 3 0 3 1.8 0 1.8 Non-respondents — — 6 — — — Total 131 39 176 77.1 22.9 100.0 77 l o c a t i o n , only one of the 40 r u r a l respondents was employed i n a department of more than f i v e t h e r a p i s t s . The r e l a t i v e l y l a r g e number of r u r a l s o l e charge t h e r a p i s t s i n d i c a t e d i n Table 1 combined with the comparatively small s i z e of departments i n r u r a l areas suggests that d i f f e r e n c e s c o u l d be expected between r u r a l and urban t h e r a p i s t s in r e l a t i o n to how they update t h e i r s k i l l s and knowledge. Years of Employment The average number of years experience i n the f i e l d of o c c u p a t i o n a l therapy f o r the sample in t h i s study was 7.49 years, with responses ranging from l e s s than one year to 30 years. The mean i s s l i g h t l y higher than that found i n McGregor's (Note 5) study which was 6.8 years and 3.5 years more than the p r o f e s s i o n a l experience r e p o r t e d i n the Hightower (1973) study. The r e s u l t s l i k e l y r e f l e c t a general trend among women h e a l t h care p r o f e s s i o n a l s to e i t h e r remain i n the work f o r c e or r e t u r n to work a f t e r an absence and to continue to work on at l e a s t a part time b a s i s a f t e r having c h i l d r e n . The mean number of years experience i n the s u p e r v i s o r y t h e r a p i s t s group was 10.42 while c l i n i c a l t h e r a p i s t s averaged 6.75 years of experience in the f i e l d of o c c u p a t i o n a l therapy. Although there i s no c u r r e n t i n f o r m a t i o n a v a i l a b l e on the norms for years of experience and l e v e l of job r e s p o n s i b i l i t y , these r e s u l t s r e f l e c t a common assumption among t h e r a p i s t s that a t t a i n i n g an a d m i n i s t r a t i v e p o s i t i o n can u s u a l l y be a t t r i b u t e d , among other t h i n g s , to the number of years the t h e r a p i s t has worked i n the f i e l d . 78 Geographic Locat ion A p p l y i n g the d e f i n i t i o n of urban and r u r a l t h e r a p i s t s adopted in t h i s study, the d i s t r i b u t i o n of t h e r a p i s t s a c c o r d i n g to geographic l o c a t i o n was 77.3%, 139 respondents, l o c a t e d i n urban c e n t e r s and 22.7%, or 37 respondents, in r u r a l a r e a s . T h i s i s r e p r e s e n t a t i v e of the a c t u a l d i s t r i b u t i o n of the sample of which approximately 81% of t h e r a p i s t s were l o c a t e d i n urban areas and 19% in r u r a l areas. The d e t a i l e d breakdown of the data a c c o r d i n g to the seven p r o v i n c i a l regions i s represented i n Table 3. As i s seen in other research i n the f i e l d of o c c u p a t i o n a l therapy, the m a j o r i t y of t h e r a p i s t s are l o c a t e d i n l a r g e m e t r o p o l i t a n areas, i n t h i s case Vancouver and V i c t o r i a (Maxwell,1977; S c o t t , Note 7). T h i s d i s t r i b u t i o n can be accounted fo r i n a number of ways. The most l i k e l y f a c t o r i s that the m a j o r i t y of employers of t h e r a p i s t s are acute and r e h a b i l t a t i o n h o s p i t a l s which are l o c a t e d i n urban areas. Another c o n s i d e r a t i o n i s that the small numbers of t h e r a p i s t s in r u r a l areas may r e f l e c t the lack of funding and t h e r e f o r e o p p o r t u n i t i e s for a l l i e d h e a l t h s e r v i c e s in o u t l y i n g areas. T r a d i t i o n a l l y , small communities and r u r a l h e a l t h u n i t s have employed p h y s i o t h e r a p i s t s as opposed to o c c u p a t i o n a l t h e r a p i s t s i f the funding f o r r e h a b i l i t a t i o n personnel i s l i m i t e d . T h i s i s another e x p l a n a t i o n f o r the d i s t r i b u t i o n found in t h i s study. The p a t t e r n c o u l d a l s o be e x p l a i n e d by the f a c t that d e s p i t e a v a i l a b l e employment o p p o r t u n i t i e s , t h e r a p i s t s do not choose to work in r u r a l areas f o r p e r s o n a l reasons. The geographic d i s t r i b u t i o n of t h e r a p i s t s a c c o r d i n g to p r o f e s s i o n a l r o l e i s presented i n Table 4. As was Table 3 Distribution of Occupational Therapists by Geographic Location Location Number of Responses Adjusted % Sample Clinicians Supervisors Total Clinicians Supervisors Total Vancouver S Lower Mainland 96 29 125 54.5 16.5 71.0 Victoria 10 1 11 5.7 0.6 6.3 Vancouver Island 9 4 13 5.1 2.3 7.4 Fraser Valley 5 0 5 2.8 0 2.8 Thompson/Okanagan 8 0 8 4.5 0 4.5 Northern Interior 6 0 6 3.4 0 3.4 Central Interior 5 3 8 2.8 1.7 4.5 Total 139 37 176 79.0 21.0 100.0 vO Table 4 Distribution of Therapists' Professional Role by Geographic Location Clinicians Supervisors Total Geographic No. of % No. of ? No. of % Classification Response Sample Response Sample Response Sample Urban 106 60.3 30 17.0 136 77.3 Rural 33 18.7 7 4.0 40 22.7 Total 139 79.0 37 21. Q 176 10Q.O 81 a n t i c i p a t e d , very few s u p e r v i s o r y t h e r a p i s t s are l o c a t e d i n r u r a l areas, in t h i s sample only 7 of the 40 (22.7) respondents were l o c a t e d o u t s i d e of Vancouver or V i c t o r i a . Opportunity f o r P r o f e s s i o n a l Contacts T h i s item was designed to assess the o p p o r t u n i t y that the respondent had to meet with c o l l e a g u e s to d i s c u s s p r o f e s s i o n a l problems and i s s u e s . Table 5 represents the r e s u l t s showing that 149 respondents, 84.7% of the sample, had o p p o r t u n i t y to meet with f e l l o w t h e r a p i s t s on at l e a s t a weekly b a s i s . One would expect that i f the m a j o r i t y of t h e r a p i s t s worked i n m e t r o p o l i t a n areas, w i t h i n a h o s p i t a l s e t t i n g , o p p o r t u n i t i e s f o r p r o f e s s i o n a l i n f o r m a t i o n exchange would be g r e a t . In r e l a t i o n to geographic l o c a t i o n and o p p o r t u n i t y f o r p r o f e s s i o n a l c o n t a c t s , r u r a l t h e r a p i s t s as a group i n d i c a t e d l e s s o p p o r t u n i t y f o r c o n t a c t s than d i d urban t h e r a p i s t s . Approximately 60% of the r u r a l group met with c o l l e a g u e s weekly or l e s s f r e q u e n t l y , 22.5% of the group l e s s than once monthly. The r e s u l t s suggest that p r o f e s s i o n a l i s o l a t i o n may be a problem for a l a r g e number of t h e r a p i s t s i n B r i t i s h Columbia. Learning Needs One of the purposes of t h i s study was to develop a needs assessment process which d e f i n e d the component p a r t s of an e d u c a t i o n a l need i n order to a s s i s t i n the program plan n i n g p r o c e s s . The t o t a l need estimate f o r each competency was made up 82 of three f a c t o r s : d e s i r e d l e v e l of competence, e x i s t i n g l e v e l of competence, and relevance of the competency t o the p r a c t i s e of o c c u p a t i o n a l therapy. Tables 6 and 7 present each of the t h i r t y competencies, the mean need estimate, and t h e i r rank in r e l a t i o n to p r o f e s s i o n a l r o l e and geographic l o c a t i o n . C o n s i d e r i n g the ranked r e s u l t s of the t o t a l sample, e v a l u a t i o n i s the area in which c o n t i n u i n g education i s most necessary. E v a l u a t i o n of pe r c e p t u a l motor s k i l l s , c o g n i t i v e f u n c t i o n , and v o c a t i o n a l s k i l l s are ranked among the top f i v e need e s t i m a t e s . The most s t r o n g l y f e l t needs appear to be i n the p s y c h o - s o c i a l realm as compared to the p h y s i c a l or motor r e l a t e d competencies. Competencies that are t r a d i t i o n a l l y r e l a t e d to the f i e l d of r e h a b i l i t a t i o n , j o i n t m o b i l i z a t i o n and e v a l u a t i o n of motor f u n c t i o n f o r example, were ranked r e l a t i v e l y low i n t h i s study. The absence of the competencies under the U t i l i z i n g Therapeutic M a t e r i a l s and Equipment category may be accounted f o r by the f a c t that p a r a - p r o f e s s i o n a l s , r e h a b i l i t a t i o n or a c t i v i t y a i d s , are beginning to re p l a c e the t h e r a p i s t in t h i s area of p r a c t i s e . In a d d i t i o n , the expansion of many r e t a i l o u t l e t s o f f e r i n g e x p e r t i s e i n the p r e s c r i p t i o n and supply of t h e r a p e u t i c equipment and m a t e r i a l s may have minimized the t h e r a p i s t s r e s p o n s i b i l i t y in t h i s competency area. Another f a c t o r that may account f o r the d i s t r i b u t i o n of t o t a l need estimate i s the c u r r e n t trend in the f i e l d of o c c u p a t i o n a l therapy to encourage the use of adaptive s k i l l s r a t h e r than the use of a i d s to overcome d y s f u n c t i o n . I t i s i n t e r e s t i n g to note that the two competencies that apply d i r e c t l y to the f i e l d of gerontology are ranked near the Table 5 Number of Opportunities for Professional Contact with Other Occupational Therapists Opportunity for Number of Responses Urban Rural Total Urban Adjusted % Sample Rural Total Daily 97 17 114 55.1 9.7 64.8 Weekly 29 6 35 16.5 3.4 19.9 Monthly 7 8 15 4.0 4.5 8.5 Less than six times annually 3 9 12 1.7 5.1 6.8 Total 136 40 176 77.3 22.7 100.0 CO LO Table 6 Total Need Estimates by Profession Role Occupational Therapy Competencies Clinicians n = 139 Supervisors n = 37 Total Sample n = 176 X Rank X Rank X Rank 1.65 7 1.73 4 1.65 8 2.57 1 1.70 5 2.39 2 2.17 3 1.68 6 2.05 3 2.53 2 2.35 1 2.50 1 1.04 23 1.76 3 1.20 19 1.64 8 2.08 2 1.72 7 0.84 29 1.27 15 0.92 22 0.98 25 1.54 11 1.'09 20 1.11 21 1.76 3 1.25 17 1.41 14 1.35 19 1.39 13 1.24 28 1.65 7 1.31 14 1.50 12 1.59 10 1.50 11 1.92 5 1.73 4 1.89 4 2.10 4 1.05a 18 1.88 5 1.40 15 0.76 22 1.26 16 0.96 26 0.54 29 0.36 23 1.10 22 1.08 17 1.09 20 1.59 9 1.51 12 1.57 9 1.00 24 0.84 20 0.98 21 1.13 20 1.60 9 1.24 18 0.82 28 0.95 19 0.86 23 0.67 30 0.73 23 0.67 24 0.87 27 0.78 21 0.86 23 1.22 19 1.14 16 1.20 19 1.37 16 0.84 20 1.25 17 1.33 17 1.27 15 1.30 15 1.52 11 1.43 13 1.49 12 1.78 6 1.54 11 1.73 6 1.45 13 1.62 8 1.39 13 1.57 10 1.27 15 1.51 10 1) identify 6 evaluate motor function 2) identify 6 evaluate perceptual-motor s k i l l s 3) identify S evaluate sensory function 4) observe E record cognitive function 5) identify E evaluate leisure 6 play s k i l l s 6) identify E evaluate vocational s k i l l s 7) identify £ evaluate A.D.L. s k i l l s 8) identify 6 evaluate functional communicating s k i l l s 9) identify E evaluate psychosocial function 10) conduct therapeutic interviews 11) select 6 adopt activities for therapeutic purposes 12) design and adapt special equipment 13) employ counselling methods 14) apply sensory-based therapies to develop perceptual motor skil l s 15) employ joint mobilization £ protection techniques 16) employ muscle strengthening techniques 17) train in work simplification 6 energy conservation techniques 18) employ behavior modification approaches 19) employ socio-drama techniques 20) employ relaxation techniques 21) employ reality orientation 22) employ activation methods 23) utilize recreation 6 leisure time activities 24) select £ utiliz e self care equipment £ materials 25) select £ utiliz e rehabilitation aids £ materials 26) select £ utiliz e mobility aids 27) select £ utiliz e avocational equipment £ materials 28) select E u t i l i z e vocational equipment £ materials 29) select £ utilize projective equipment £ materials 30) select £ utiliz e developmental equipment 6 materials t = 2.03 df = 175 p < .04 CO Table 7 Total Need Estimates by ( Occupational Therapy Competencies 1) identify 6 evaluate motor function 2) identify S evaluate perceptual-motor s k i l l s 3) identify 6 evaluate sensory function 4) observe £ record cognitive function 5) identify £ evaluate leisure 6 play ski l l s 6) identify £ evaluate vocational s k i l l s 7) identify £ evaluate A.D.L. s k i l l s 8) identify £ evaluate functional caimunication s k i l l s 9) identify E evaluate psychosocial function 10) conduct therapeutic interviews 11) select £ adopt activities for therapeutic purposes 12) design and adapt special equipment _13) employ counselling methods 11) apply sensory-based therapies to develop perceptual motor s k i l l s 15) employ joint mobilization £ protection techniques 16) employ muscle strengthening techniques 17) train in work simplification £ energy conservation techniques 18) employ behavior modification approaches 19) employ socic—drama techniques 20) employ relaxation techniques 21) employ reality orientation 22) employ activation methods 23) utilize recreation £ leisure time activities 24) select £ u t i l i z e self care equipment £ materials 25) select £ utiliz e rehabilitation aids £ materials 26) select £ u t i l i z e mobility aids 27) select £ u t i l i z e avocational equipment £ materials 28) select £ u t i l i z e vocational equipment £ materials 29) select £ u t i l i z e projective equipment £ materials 30) select £ utilize developmental equipment £ materials *t = -1.99 df r 175 p< .04 bt = -2.15 df r 175 p < .03 Urban Rural Total Sample n = 136 n = 40 n = 176 Rank x Rank x Rank 1.58 6 1.33 16 1.65 8 2.39 2 2.67 1 2.39 2 2.07 3 2.09 4 2.05 3 2.44 1 2.42 2 2.50 1 0.88 23 1.49 13 1.20 19 1.66 7 1.45 14 1.72 7 0.70 27 0.76 20 0.92 22 0.75 26 1.58 12 1.09 20 0.99 22 1.36 15 1.25 17 1.48 8 1.09 17 1.39 13 1.03 20 1.45 14 1.31 14 1.45 10 1.00 18 1.50 11 1.78 5 2.33 3 1.89 4 2.02 4 1.94 7 1.88 5 1.89 16 1.94 7 1.26 16 0.99 22 0.70 21 0.36 23 1.05 19 0.79 19 1.09 20 1.42 12 2.00 6 1.57 9 0.85 24 1.45a 14 0:98 21 1.14 17 1.09v 17 1.24 18 0.64 28 1.36b 15 0.86 23 1.00 21 0.42 22 0.67 24 0.79 25 1.09 17 0.86 23 1.11 18 1.58 11 1.20 19 1.26 15 1.70 10 1.25 17 1.27 14 1.48 13 1.30 15 1.44 11 1.73 9 1.49 12 1.71 6 1.94 7 1.73 6 1.31 13 1.81 8 1.39 13 1.46 9 2.03 5 1.51 10 86 bottom of the competency l i s t . C o n s i d e r i n g the comparatively l a r g e number of employment o p p o r t u n i t i e s i n t h i s area and the 'high p r o f i l e that the f i e l d i s r e c e i v i n g i n the h e a l t h care i n d u s t r y , the f a c t that the r e a l i t y o r i e n t a t i o n competency was ranked 22 and the a c t i v a t i o n competency 24 was unexpected. Table 6 presents the d i s t r i b u t i o n of l e a r n i n g needs acc o r d i n g to the p r o f e s s i o n a l r o l e of the respondent. As seen i n the a n a l y s i s of the t o t a l sample, e v a l u a t i o n r e l a t e d competencies are ranked h i g h l y by both groups although the s p e c i f i c areas of e v a l u a t i o n d i f f e r e d i n r e l a t i o n to r o l e . S u p e r v i s o r s p e r c e i v e d c l i n i c a l t h e r a p i s t s ' needs to be high i n c o g n i t i v e , v o c a t i o n a l , and l e i s u r e s k i l l s e v a l u a t i o n while c l i n i c i a n s r e p o r t e d perceptual-motor, sensory, and c o g n i t i v e e v a l u a t i o n as areas i n which l e a r n i n g needs e x i s t e d . One competency area showed a major d i f f e r e n c e in p e r c e p t i o n s h e l d by c l i n i c i a n s and s u p e r v i s o r s in r e l a t i o n to needs. C l i n i c i a n s c o n s i d e r e d a p p l i c a t i o n of sensory-based t h e r a p i e s areas of g r e a t e r need than d i d s u p e r v i s o r y t h e r a p i s t s . The remainder of the 30 competency areas were p e r c e i v e d as s i m i l a r by both groups in r e l a t i o n to l e a r n i n g needs. Again, the need estimate i n e v a l u a t i o n areas were i l l u s t r a t e d when the data was analyzed i n r e l a t i o n to the geographic l o c a t i o n of the respondents. There were two s i g n i f i c a n t d i f f e r e n c e s i n p e r c e p t i o n s of needs when the sample was compared a c c o r d i n g to geographic l o c a t i o n . Rural t h e r a p i s t s c o n s i d e r e d employing socio-drama techniques and r e a l i t y o r i e n t a t i o n to be areas of g r e a t e r need than d i d urban t h e r a p i s t s . T h i s f i n d i n g i s s u r p r i s i n g c o n s i d e r i n g the g e n e r a l l y 87 accepted assumption that r u r a l t h e r a p i s t s tend to be l e s s s p e c i a l i z e d than t h e i r urban c o l l e a g u e s . Relevance of Competencies The relevance of each competency to the r o l e of the o c c u p a t i o n a l t h e r a p i s t was one of the three f a c t o r s used i n the computation of t o t a l need estimate f o r each competency area. In a d d i t i o n , the relevance of each competency alone i s important i n program planning i n that i t r e f l e c t s one aspect of the d e c i s i o n making process. For i n s t a n c e , when c o n s i d e r i n g the p r i o r i t y of programs, even though t h e r a p i s t s may i n d i c a t e that needs are equal in d i f f e r e n t areas, i f one i s more r e l e v a n t to the p r a c t i c e of o c c u p a t i o n a l therapy, that f a c t would be i n f l u e n t i a l i n the implementation of one program before another. Tables 8 and 9 present the relevance of each competency in r e l a t i o n to p r o f e s s i o n a l r o l e and geographic l o c a t i o n of the respondent r e s p e c t i v e l y . The frequency of response of high r e l e v a n c e , d e f i n e d i n t h i s study as 3 on a s c a l e the percent of sample and the rank. C o n s i d e r i n g the t o t a l sample, the competencies r e l a t e d to s e l f - c a r e are the most r e l e v a n t , with i d e n t i f i c a t i o n and e v a l u a t i o n of a c t i v i t i e s of d a i l y l i v i n g s k i l l s ranked f i r s t and s e l e c t i o n and u t i l i z a t i o n of s e l f - c a r e equipment and m a t e r i a l s as f i v e . The top ranked competencies tend to r e f l e c t those areas that o c c u p a t i o n a l t h e r a p i s t s are most commonly a s s o c i a t e d with, those with an a c t i v i t y or d a i l y l i v i n g o r i e n t a t i o n . Of the three broad c a t e g o r i e s of competency, e v a l u a t i o n i s c l e a r l y c o n s i d e r e d the most r e l e v a n t . These competencies a l s o r e f l e c t concepts that are in common usage V Table 8 Relevance of Competencies by Professional Role Occupational Therapy Competencies Clinicians n = 139 Supervisors n = 37 Total Sample n = 176 "T -Number ~% Number % Number - Response Sample Rank Response Sample Rank Response Sample Rank 1) identify £ evaluate motor function 2) identify £ evaluate perceptual-motor s k i l l s 3) identify £ evaluate sensory function 4) observe £ record cognitive function 5) identify £ evaluate leisure £ play s k i l l s 6) identify £ evaluate vocational skills 7) identify £ evaluate A.D.L. skill s 8) identify £ evaluate functional ccmmunicaticnal s k i l l s 9) identify £ evaluate psychosocial function 10) conduct therapeutic interviews 11) select £ adopt activities for therapeutic purposes 12) design and adapt special equipment 13) employ counselling methods 14) apply sensory-based therapies to develop perceptual motor sk i l l s 15) employ joint mobilization £ protection techniques 16) employ msucle strengthening techniques 17) train in work simplification £ energy conservation techniques 18) employ behavior modification approaches 19) employ socic—drama techniques 20) employ relaxation techniques 21) employ reality orientation 22) employ activation methods 23) u t i l i z e recreation £ leisure time activities 24) select £ utiliz e self care equipment E materials £ u t i l i z e rehabilitation aids £ materials £ utiliz e mobility aids £ u t i l i z e avocational equipment £ materials t o / o c i c v . t £ utiliz e vocational equipment £ materials 29) select £ utilize projective equipment £ materials 30) select £ u t i l i z e developmental equipment £ materials 25) 26) 27) 28) select select select selec 95 86 76 85 75 56 117 83 78 96 106 77 61 72 54 44 69 46 27 52 70 73 67 85 77 65 44 36 32 43 67.4 61.0 53.9 60.3 53.2 39.7 83.0 58.9 55.3 68.1 75.2 54.6 43.3 51.1 38.3 31.2 48.9 32.6 19.1 36.9 49.6 51.8 47.5 60.3 54.6 46.1 31.2 25.5 22.7 30.5 4 5 10 6 11 19 1- 7 8 3 2 9 18 13 20 23 15 22 27 21 14 12 16 6 9 17 23 25 26 24 26 23 22 21 20 15 31 25 22 23 29 26 19 23 20 15 24 16 9 13 18 18 17 27 22 22 16 11 7 18 70.3 62.2 59.5 56.8 54.1 40 83 67 59 62 78.4 70.3 51.4 62.2 .1 .5 .9 .2 .3 .1 54. 40. 64. 43. 24. 35. 48.6 48.6 45.9 73.0 59.5 59.5 43.2 29.7 18.9 48.6 4 7 8 9 10 15 1 5 8 7 2 4 11 7 10 15 6 14 17 15 12 12 13 3 8 8 14 16 18 12 121 109 98 106 95 71 148 108 100 119 135 103 80 95 74 59 93 62 36 65 88 91 84 112 99 87 60 47 38 60 68. 61. 55. 59. 53. 40.2 83.2 60.9 56.4 67.0 76.0 58.1 45.3 53.6 41.9 33.5 52.5 34.6 20.1 36.9 49.7 51.4 47.5 63. 55. 49. 34. 26.8 21.8 34.1 .1 .9 .2 .1 3 6 12 8 14 22 1 7 10 4 2 9 20 13 21 27 16 25 29 23 17 15 19 5 11 18 24 28 30 26 Note: Data indicate number of respondents choosing 3 on scale of 3 referring to relevance ot competency to Occupational Therapy. oo 00 Table 9 Relevance of Competencies by Geographic Classification Occupational Therapy Competencies Urban n = 136 Rural n = 40 Total Sample n = 176 Number % Number '• 5 Number % Response Sample Rank Response Sample Rank Response Sample Rank identify £ evaluate motor function identify £ evaluate perceptual-motor s k i l l s identify £ evaluate sensory function observe £ record cognitive function identify £ evaluate leisure £ play s k i l l s identify £ evaluate vocational s k i l l s identify 6 evaluate A.D.L, sk i l l s identify £ evaluate functional communicational s k i l l s identify £ evaluate psychosocial function conduct therapeutic interviews select £ adopt activities for therapeutic purposes design and adapt special equipment employ counselling methods apply sensory-based therapies to develop perceptual motor sk i l l s employ joint mobilization £ protection techniques employ muscle strengthening techniques train in work simplification £ energy conservation techniques employ behavior modification approaches employ socio-drama techniques employ relaxation techniques employ reality orientation employ activation methods uti l i z e recreation £ leisure time activities select £ u t i l i z e self care equipment £ materials select £ u t i l i z e rehabilitation aids £ materials select £ u t i l i z e mobility aids select 6 utili z e avocational equipment £ materials select £ u t i l i z e vocational equipment £ materials select £ utili z e projective equipment £ materials select £ utilize developmental equipment £ materials 92 67.6 3 27 67.5 3 119 68.2 3 80 58.8 6 27 67.5 3 107 61.5 6 71 52.2 11 25 62.5 5 96 55.3 12 82 60.3 5 23 57.5 7 105 59.8 8 73 53.7 10 21 52.5 9 94 53.6 14 58 42.6 17 12 30.0 14 70 40.2 22 111 81.6 1 35 87.5 1 146 83.2 1 80 58.8 6 26 65.0 4 106 60.9 7 76 55.9 8 22 55.0 8 98 56.4 10 92 67.6 3 25 62.5 5 117 67.0 4 101 74.3 2 32 80.0 2 133 76.0 2 77 56.6 7 24 60.0 6 101 58.1 9 60 44.1 16 19 47.5 10 79 45.3 20 70 51.5 12 23 57.5 7 93 53.6 13 56 41.2 18 18 45.0 11 74 41.9 21 47 34.6 21 12 30.0 14 59 33.5 27 70 51.5 12 21 52.5 9 91 52.5 16 43 31.6 22 18 45.0 11 61 34.6 25 25 18.4 26 11 27.5 15 36 20.1 29 48 35.3 20 17 42.5 12 65 36.9 23 68 50.0 14 19 47.5 10 88 49.7 17 69 50.7 13 21 52.5 9 90 51.4 15 68 50.0 14 16 40.0 13 84 47.5 19 85 62.5 4 25 62.5 5 100 63.1 5 74 54.4 9 23 57.5 7 97 55.9 11 61 44.9 15 24 60.0 6 85 49.2 18 53 39.0 19 6 15.0 17 59 34.1 24 40 29.4 24 6 15.0 17 46 26.8 28 28 20.6 25 10 25.0 16 38 21.8 30 42 30.9 23 18 45.0 11 60 34.1 26 Note: Data indicate nunber of respondents choosing 3 on scale of 3 referring to relevance of competency to Occupational Therapy. CO 90 among t h e r a p i s t s reducing the tendency for terminology to be ambiguous, a common phenomena in the f i e l d of o c c u p a t i o n a l therapy. I t i s i n t e r e s t i n g to note that the most r e l e v a n t competencies are those that are r e l a t i v e l y unique to the o c c u p a t i o n a l t h e r a p i s t as compared to the p h y s i o t h e r a p i s t . The issue of p r o f e s s i o n a l i d e n t i t y may i b e r e f l e c t e d in these r e s u l t s . A comparison of the p e r c e i v e d relevance of the 30 competency areas a c c o r d i n g to the p r o f e s s i o n a l r o l e of the respondent r e v e a l s only minor d i f f e r e n c e s in p e r c e p t i o n s h e l d by c l i n i c i a n s and s u p e r v i s o r s i n the top ranked competencies. Of the f i v e competencies p e r c e i v e d as most r e l e v a n t , a l l were ranked s i m i l a r i l y by the two groups except f o r s e l e c t i o n and u t i l i z a t i o n of s e l f - c a r e equipment which was c o n s i d e r e d more r e l e v a n t by c l i n i c i a n s than s u p e r v i s o r s as suggested by g r e a t e r than 15% d i f f e r e n c e i n the number of respondents ranking i t as h i g h l y r e l e v a n t . Three other competency areas d i f f e r e d i n p e r c e p t i o n of relevance by 15% although they were ranked among the l e s s r e l e v a n t of the competencies s t u d i e d . Adapting s p e c i a l equipment, t r a i n i n g i n work s i m p l i f i c a t i o n , and u t i l i z i n g developmental equipment were p e r c e i v e d as more r e l e v a n t to the c l i n i c i a n ' s p r a c t i c e i n o c c u p a t i o n a l therapy by c l i n i c i a n s than s u p e r v i s o r s . The d i s t r i b u t i o n of competencies a c c o r d i n g to geographic l o c a t i o n are reported i n Table 9. The s i m i l a r i t y of p e r c e p t i o n of relevance of the 30 competencies h e l d by urban and r u r a l t h e r a p i s t s i s i n d i c a t e d i n the r e s u l t s . The three top ranked competencies, e v a l u a t i o n of a c t i v i t i e s of d a i l y l i v i n g , adapting 91 a c t i v i t i e s f o r t h e r a p e u t i c purposes, and e v a l u a t i o n of motor f u n c t i o n are the same f o r both groups of respondents. Only three competency areas r e v e a l e d major d i s c r e p a n c i e s between these two groups. R u r a l t h e r a p i s t s p e r c e i v e d e v a l u a t i o n of sensory f u n c t i o n , t r a i n i n g i n work s i m p l i f i c a t i o n , and s e l e c t i o n of m o b i l i t y a i d s as more r e l e v a n t to p r a c t i c e of o c c u p a t i o n a l therapy than d i d urban t h e r a p i s t s . A v a i l a b i l i t y of T r a i n i n g O p p o r t u n i t i e s The a v a i l a b i l i t y of t r a i n i n g o p p o r t u n i t i e s in the 30 competency areas was assessed i n order to supplement i n f o r m a t i o n provided by the t o t a l needs estimate in r e l a t i o n to program p l a n n i n g . For instance i f both the t o t a l need estimate and a v a i l a b l i t y of t r a i n i n g are high, the q u a l i t y of the c u r r e n t programs or t h e i r u t i l i t y to the o c c u p a t i o n a l t h e r a p i s t s p r a c t i s e should be assessed. Tables 10 and 11 represent the frequency of response and percent of sample which choose the "no t r a i n i n g a v a i l a b l e " responses to the 30 competencies. The r e s u l t s in r e l a t i o n to the t o t a l sample r e v e a l e d that on a l l competencies at l e a s t 55% of the t h e r a p i s t s s t a t e d that there were no t r a i n i n g o p p o r t u n i t i e s a v a i l a b l e in the area. The f i v e areas which had the h i g h e s t mean responses were as f o l l o w s : i d e n t i f y and evaluate v o c a t i o n a l s k i l l s , s e l e c t and u t i l i z e a v o c a t i o n a l equipment and m a t e r i a l s , s e l e c t and u t i l i z e v o c a t i o n a l equipment and m a t e r i a l s , employ socio-drama techniques, i d e n t i f y and e v a l u a t e l e i s u r e and p l a y s k i l l s . The r e s u l t s c l e a r l y i n d i c a t e a l a c k of t r a i n i n g i n v o c a t i o n a l l y - o r i e n t e d competencies. T h i s may be p a r t i a l l y Table 10 Perceived Availability of Training by Professional Role Occupational Therapy Competencies 1) identify £ evaluate motor function 2) identify £ evaluate perceptual-motor s k i l l s 3) identify £ evaluate sensory function 4) observe £ record cognitive function 5) identify £ evaluate leisure £ play s k i l l s 6) identify £ evaluate vocational ski l l s 7) identify £ evaluate A.D.L. sk i l l s 8) identify £ evaluate functional ccmmunicational s k i l l s 9) identify £ evaluate psychosocial function 10) conduct therapeutic interviews .11) select E adopt activities far therapeutic purposes 12) design and adapt special equipment 13) employ counselling methods 14) apply sensory-based therapies to develop p>erceptuai motor s k i l l s 15) employ joint mobilization E protection techniques 16) employ muscle strengthening techniques 17) train in work simplification £ energy conservation techniques 18) employ behavior modification approaches 19) employ socio-drama techniques 20) employ relaxation techniques 21) employ reality orientation 22) employ activation methods 23) utiliz e recreation £ leisure time activities 24) select £ utiliz e self care equipment £ materials £ utiliz e rehabilitation aids £ materials £ u t i l i z e mobility aids £ u t i l i z e avocational equipment £ materials £ u t i l i z e vocational equipment £ materials £ u t i l i z e projective equipment £ materials 25) 26) 27) 28) 29) 30) select select select select select select E u t i l i z e developmental equipment £ materials Clinicians n = 139 Number 5 Response Sample Rank Supervisors n = 37 Number ? Response Sample Rank Total Sample n = 176 Number ? Response Sample Rank 82 58.2 17 16 43.2 11 98 54.7 18 87 61.7 13 22 59.5 9 109 60.9 14 93 66.0 9 22 59.5 9 115 64.2 10 103 73.0 3 27 73.0 4 130 73.9 4 101 71.6 5 30 81.1 2 131 73.7 3 110 78.0 1 31 83.8 1 141 79.3 1 80 56.7 18 22 59.5 9 102 57.0 17 89 63.1 11 21 56.8 10 110 61.5 13 96 68.1 7 22 59.5 9 118 65.9 8 94 66.7 8 22 59.5 9 116 64.8 9 94 66.7 8 25 67.6 6 119 67.0 . 7 94 66.7 8 26 70.3 5 120 67.0 7 93 66.0 9 23 62.2 8 116 64.8 8 76 53.9 19 18 48.6 10 94 52.5 19 83 58.9 16 22 59.5 8 105 58.7 16 86 61.0 14 23 62.2 8 109 60.9 13 88 62.4 12 27 73.0 4 115 64.2 10 89 63.1 11 25 67.6 6 114 64.2 10 105 74.5 2 27 73.0 4 132 74.3 2 88 62.4 11 22 59.5 9 110 61.5 12 89 63.1 12 24 64.9 7 113 63.7 11 91 64.5 10 25 67.6 6 116 64.8 9 87 61.7 13 23 62.2 8 110 62.0 12 84 59.6 15 23 62.2 8 107 59.8 15 86 61.0 14 24 65.9 7 110 61.5 13 87 61.7 13 23 62.9 8 110 61.5 13 102 72.3 4 30 81.1 2 132 73.7 3 102 72.3 4 27 73.0 4 129 72.6 5 99 70.2 6 26 70.3 5 125 70.4 6 101 71.6 5 29 78.4 3 130 72.6 5 Note: Data indicate number of respondents stating training opportunities are presently available in this competency area. vO t o . Table 11 Perceived Availability of Training by Geographic Classification Occupational Therapy Competencies 1) identify £ evaluate motor function 2) identify £ evaluate perceptual-motor s k i l l s 3) identify £ evaluate sensory function 4) observe £ record cognitive function 5) identify £ evaluate leisure £ play s k i l l s 6) identify £ evaluate vocational s k i l l s 7) identify £ evaluate A.D.L. s k i l l s 8) identify £ evaluate functional communicational s k i l l s 9) identify £ evaluate psychosocial function 10) conduct therapeutic interviews 11) select £ adopt activities far therapeutic purposes 12) design and adapt special equipment 13) employ counselling methods 14) apply sensory-based therapies to develop perceptual motor skil l s 15) employ joint mobilization £ protection techniques 16) employ muscle strengthening techniques 17) train in work simplification £ energy conservation techniques 18) employ behavior modification approaches 19) employ socio-drama techniques 20) employ relaxation techniques 21) employ reality orientation 22) employ activation methods 23) u t i l i z e recreation E leisure time activities 24) select £ utiliz e self care equipment E materials 25) select E utiliz e rehabilitation aids £ materials 26) select £ utiliz e mobility aids 27) select £ utilize avocational equipment £ materials 28) select £ utilize vocational equipment £ materials 29) select E utiliz e projective equipment £ materials 30) select E utilize developmental equipment £ materials Urban Rural Total Sample n = 136 n = 33 n = 176 Number % Number % Number % Response Sample Rank Response Sample Rank Response Sample Rank 68 50.0 18 28 70.0 9 96 54.7 18 74 54.4 16 33 82.5 4 107 60.9 14 81 59.6 11 32 80.0 5 113 64.2 10 94 69.1 4 34 85.0 3 128 73.9 4 94 69.1 4 35 87.5 2 129 73.7 3 103 75.7 1 36 90.0 1 139 79.3 1 69 50.7 17 31 77.5 6 100 57.0 17 74 54.4 16 34 85.0 3 108 61.5 13 85 62.5 7 31 77.5 6 116 65.9 8 80 58.8 12 34 85.0 3 114 64.8 9 83 61.0 9 34 85.0 3 117 67.0 7 87 64.0 6 31 77.5 6 118 67.0 7 85 62.5 7 29 72.5 8 114 64.8 8 62 45.6 19 30 75.0 7 92 52.5 19 75 55.1 15 28 70.0 9 103 58.7 16 78 57.4 13 29 72.5 8 107 60.9 13 84 61.8 8 29 72.5 8 113 64.2 10 80 58.8 12 32 80.0 5 112 64.2 10 97 71.3 2 33 82.5 4 130 74.3 2 77 56.6 14 31 77.5 6 108 61.5 12 80 58.8 12 31 77.5 6 111 63.7 11 82 60.3 10 32 80.0 5 114 64.8 9 77 56.6 14 31 77.5 6 108 62.0 12 74 54.4 16 31 77.5 6 105 59.8 15 77 56.6 14 31 77.5 6 108 61.5 13 75 55.1 15 33 82.5 4 108 61.5 13 96 70.6 3 34 85.0 3 130 73.7 3 94 69.1 4 33 82.5 4 127 72.6 S 90 66.2 5 33 82.5 4 123 70.4 6 94 69.1 4 34 85.0 13 128 72.6 5 Note: Data i n d i c a t e number of respondents s t a t i n g t r a i n i n g o p p o r t u n i t i e s are presently a v a i l a b l e i n t h i s competency area U3 co 94 e x p l a i n e d by the f a c t that although v o c a t i o n a l e v a l u a t i o n and treatment are wi t h i n the mandate of the t h e r a p i s t , i t i s not emphasized e i t h e r i n the l i t e r a t u r e or undergraduate t r a i n i n g . Again, the p s y c h o s o c i a l competencies were emphasized i n comparison to the p h y s i c a l l y r e l a t e d areas. The areas where the absence of t r a i n i n g i s most n o t i c a b l e are those areas of r e h a b i l i t a t i o n where p h y s i o t h e r a p i s t s ' and o c c u p a t i o n a l t h e r a p i s t s ' a c t i v i t i e s do not o v e r l a p . F r e q u e n t l y . a c o n t i n u i n g education program i s o f f e r e d f o r both p r o f e s s i o n a l groups, f o c u s s i n g on the s k i l l s and knowledge common to both. The small number of o c c u p a t i o n a l t h e r a p i s t s that work i n areas not shared to some extent with p h y s i o t h e r a p i s t s may not be adequate to support t h e i r own c o n t i n u i n g education programs. When the data p e r t a i n i n g to the a v a i l a b i l i t y of t r a i n i n g o p p o r t u n i t i e s was analyzed i n r e l a t i o n to p r o f e s s i o n a l r o l e of the respondent, there were no major d i s c r e p a n c i e s between the pe r c e p t i o n s of c l i n i c i a n s and s u p e r v i s o r s . When the sample was cons i d e r e d i n r e l a t i o n to geographic l o c a t i o n both urban and r u r a l t h e r a p i s t s emphasized the lack of v o c a t i o n a l l y - r e l a t e d programs although major d i f f e r e n c e s in p e r c e p t i o n s were noted i n four other competency areas. Rural t h e r a p i s t s p e r c e i v e d conducting t h e r a p e u t i c i n t e r v i e w s , behavior m o d i f i c a t i o n , and f u n c t i o n a l communication as areas having l e s s o p p o r t u n i t y f o r t r a i n i n g than urban t h e r a p i s t s . S i m i l a r to d i f f e r e n c e s i n pe r c e p t i o n of relevance of competencies, the e v a l u a t i o n of sensory f u n c t i o n was an area of major d i f f e r e n c e between r u r a l and urban t h e r a p i s t s , r u r a l t h e r a p i s t s more of t e n i d e n t i f y i n g i t as an area i n which t r a i n i n g i s l a c k i n g . 95 B a r r i e r s to P a r t i c i p a t i o n The t h e r a p i s t s ' p e r c e p t i o n s of b a r r i e r s to p a r t i c i p a t i o n are presented in Tables 12 an 13. Using the mean ranking of the t o t a l sample as an estimate of importance, s i t u a t i o n a l b a r r i e r s were i d e n t i f i e d more of t e n than i n s t i t u t i o n a l ones. In order of t h e i r importance, family r e s p o n s i b i l i t y , lack of a p p r o p r i a t e programs, lack of time, and job r e s p o n s i b i l i t i e s were i d e n t i f i e d as the . major b a r r i e r s to p a r t i c i p a t i o n in c o n t i n u i n g education programs. The McGregor (Note 5) study a l s o suggested lac k of s u i t a b l e programs as a major b a r r i e r , however, cost was ranked e q u a l l y high i n her study. I t i s i n t e r e s t i n g to note that d e s p i t e the i n c r e a s i n g numbers of groups o f f e r i n g c o n t i n u i n g education o p p o r t u n i t i e s , i n c l u d i n g s p e c i a l i n t e r e s t groups, p r o v i n c i a l and n a t i o n a l p r o f e s s i o n a l o r g a n i z a t i o n s , and the u n i v e r s i t i e s , l a c k of a p p r o p r i a t e programs continues to be c o n s i s t e n t l y i d e n t i f i e d as a major b a r r i e r to p a r t i c i p a t i o n . The a n a l y s i s of the data in respect to respondent's p r o f e s s i o n a l r o l e revealed that both s u p e r v i s o r s and c l i n i c i a n s p e r c e i v e f a m i l y r e s p o n s i b i l i t i e s and lack of time as major b a r r i e r s to c l i n i c i a n s a t t e n d i n g continung education programs. S u p e r v i s o r s , however, p e r c e i v e d lack of a p p r o p r i a t e programs as a b a r r i e r more o f t e n than c l i n i c i a n s who i n d i c a t e d that job r e s p o n s i b i l i t y and cost were grea t e r d e t e r r e n t s than lack of a p p r o p r i a t e programs. As was expected, the breakdown of p e r c e i v e d b a r r i e r s by geographic l o c a t i o n r e v e a l e d that r u r a l t h e r a p i s t s ranked d i s t a n c e as the top b a r r i e r to p a r t i c i p a t i o n , with 15 r u r a l Table 12 Ranking Perceived Barriers to Participation by Professional Role Barriers Clinicians n = 139 Supervisors n = 37 Total Sample n = 176 Family responsibilities Job responsibilities Cost Distance Lack of time Transportation No appropriate program available Insufficient advance notice Inadequate publicity Inconvenient scheduling 18 4 8 17 13 14 29 41 23 16 16 19 19 17 16 1 2 2 16 15 14 6 7 8 3 5 11 5 11 12 Situational Barriers 1.67 1.93 1.94 2.06 1.94 2.20 6 2 7 4 5 0 2 7 4 3 8 0 2 1.60 24 6 10 1.65 3 2.08 19 20 17 1.96 10 2.14 36 45 33 1.97 2 1.78 20 19 21 2.01 3 1.87 24 25 19 1.93 0 0 1 2 2 2.20 Institutional Barriers 1.96 2.09 2.42 2.25 0 0 2 1.78 23 17 18 1.91 2.62 6 10 13 2.24 2.00 3 8 11 2.36 2.00 7 13 19 2.20 a l = number of times response ranked as 1st most frequently encountered terrier. 2 : Z b e r of times response ranked as 2nd most frequently encountered barrier. 3 "= n l X r of S i s response ranked as 3rd most frequently encountered barrier. bmean rank with lower value signifying higher rank. ON Table 13 Ranking Perceived Barriers to Participation by Geographic Location Urban Rural Total Sample Barriers n = 136 n = HO ._ l a 2 3 X 1 2 3 X 1 2 3 X Situational Barriers Family responsibilities 18 6 3 1.44 6 0 7 2.08a 24 6 10 1.65 Job responsibilities 17 20 14 1.94 2 0 3 2.20D 19 20 17 1.96 Cost 29 30 25 1.95 5 15 8 2.10 36 45 33 1.97 Distance 5 9 12 2.27 15 9 9 1.18° 20 19 21 2.01 Lack of time 24 23 17 1.81 0 2 1 2.33d 24 25 19 1.92 Transportation 0 0 2 3.00 1 2 0 1.66 1 2 2 2.20 Institutional Barriers No appropriate program available 20 11 15 1.89 3 5 3 2.00 23 17 18 1.91 Insufficient advance 10 13 2.24 notice 4 8 11 2.30 2 2 2 2.00 6 Inadequate publicity 3 7 9 2.31 0 1 1 2.50 3 8 11 2.36 Inconvenient scheduling 6 11 14 2.25 0 1 2 1.68e 7 13 14 2.21 ^au = .14 p < .05 ^ a u = -.20 p < .007 'TTau = .49 p < ,02 ^Taa = -.30 p < .003 ^Tau = .16 p < .03 v O 98 t h e r a p i s t s ranking i t as the most f r e q u e n t l y encountered b a r r i e r compared to 5 urban t h e r a p i s t s . Although t r a n s p o r t a t i o n a l s o ranked h i g h among r u r a l t h e r a p i s t s when mean ranks are compared, only f i v e t h e r a p i s t s i n the t o t a l sample acknowledged i t as a b a r r i e r . Urban t h e r a p i s t s ranked f a m i l y r e s p o n s i b i l i t y and inconvenient scheduling s i g n i f i c a n t l y higher than d i d t h e i r r u r a l c o l l e a g u e s . It would appear from these r e s u l t s that i t i s the choice of <» t o p i c r a t h e r than the program planning process that the t h e r a p i s t s p e r c e i v e as a b a r r i e r to p a r t i c i p a t i o n . Scheduling, p u b l i c i t y , and n o t i c e are s u f f i c e n t l y w ell organized that i f the t o p i c i s r e l e v a n t and the t h e r a p i s t ' s p e r s o n a l s i t u a t i o n f l e x i b l e , p a r t i c i p a t i o n c o u l d be expected. In Chapter Three, the t h i r d category of b a r r i e r was b r i e f l y i n t r o d u c e d and the r a t i o n a l e f o r not i n c l u d i n g i t i n t h i s study presented. Only one respondent i n d i c a t e d that they were not i n t e r e s t e d i n c o n t i n u i n g education because they d i d not t h i n k i t necessary f o r c o n t i n u i n g competence. T h i s supports the r e s e a r c h on d i s p o s i t i o n a l b a r r i e r s suggesting that respondents w i l l not s t a t e t h i s type of b a r r i e r i f given the op p o r t u n i t y on an open ended "other" item on a q u e s t i o n n a i r e . D e l i v e r y Systems Con t i n u i n g education programs may take a v a r i e t y of forms. Those d e l i v e r y systems that were i n c l u d e d in t h i s study r e f l e c t those most of t e n appearing i n the r e l a t e d l i t e r a t u r e . Tables 14 and 15 represent the d i s t r i b u t i o n of p r e f e r r e d d e l i v e r y system . 99 C o n s i d e r i n g the broad c a t e g o r i e s of systems used in t h i s study as d i r e c t and d i s t a n c e , the four examples of d i r e c t systems were ranked higher than any of the d i s t a n c e systems. Workshops were ranked s i g n i f i c a n t l y higher than any other type of system with 166 (95%) of the respondents ranking i t as one of the top three p r e f e r e n c e s of d e l i v e r y system. The preference for workshops may r e f l e c t the f a c t that few other d e l i v e r y systems have been u t i l i z e d i n B r i t i s h Columbia, the resultsmay i l l u s t r a t e d a f a m i l i a r i t y with t h i s system rather than a preference in comparison to o t h e r s . Perhaps t h i s i s because the workshop i s the most s u i t a b l e d e l i v e r y system for the subject matter in c o n t i n u i n g education programs for t h e r a p i s t s . Table 14 presents p r e f e r r e d d e l i v e r y systems a c c o r d i n g to p r o f e s s i o n a l r o l e . Both groups p e r c e i v e d workshops as the system most p r e f e r r e d by c l i n i c a l t h e r a p i s t s . The r e s u l t s i n d i c a t e that s u p e r v i s o r s p e r c e i v e c l i n i c i a n s as p r e f e r r i n g t r a v e l l i n g c o n s u l t a n t s most o f t e n a f t e r workshops while c l i n i c i a n s p r e f e r r e d short courses as a second c h o i c e . C o n s i d e r i n g the p r e f e r r e d d e l i v e r y systems in r e l a t i o n to geographic l o c a t i o n , r u r a l t h e r a p i s t s p r e f e r t r a v e l l i n g c o n s u l t a n t s more than t h e i r urban c o l l e a g u e s . T h i s r e f l e c t s the present s t a t e of c o n t i n u i n g education in B r i t i s h Columbia since most programs are o f f e r e d i n m e t r o p o l i t a n areas, urban t h e r a p i s t s would have l e s s need f o r t r a v e l l i n g c o n s u l t a n t s . The r e l a t i v e l y low p r e f e r e n c e i n d i c a t e d f o r d i s t a n c e systems by r u r a l t h e r a p i s t s was an unexpected r e s u l t which may be an i n d i c a t i o n of lack of f a m i l i a r i t y with the systems s t u d i e d or of Table 14 Ranking Preferred Delivery Systems for by Professional Role Clinicals Supervisors Total Sample Delivery System n = 139 n = 37 n = 176 l a 2 3 - b X 1 2 3 x 1 2 3 X Direct Systems 1 or 2 day workshops 99 20 12 1.33 29 4 2 1.23 128 24 14 1.31 Short courses 11 31 23 2.19 0 7 8 2.53 11 38 31 2.25 Evening series 8 35 22 2.21 3 7 7 2.24 11 42 29 2.20 Travelling consult. 8 25 20 2.23 2 9 5 2.19 10 34 25 2.22 Distance Systems Audio tapes 1 7 18 2.65 1 3 6 2.50 2 10 24 2.61 Educational t.v. 7 11 25 2.42 1 4 4 2.33 8 15 29 2.40 Educational radio 0 2 0 2.00 0 0 1 3.00 0 1 1 2.50 Correspondence 1 2 9 2.67 0 0 0 0.00 1 2 9 2.67 = number of times response ranked 1st most preferred. 2 = number of times response ranked 2nd most preferred. 3 = number of times response ranked 3rd most preferred. mean rank with lower value signifying greater preference. Table 15 Ranking Preferred Delivery Systems in by Geographic Location Urban Rural Total Sample Delivery System n = 136 n = 40 n = 176 I 6 1 2 3 W~ I 5~~3 x~~' "1 2~1 X Direct Systems 1 or 2 day workshops 102 17 10 1.29 24 7 4 1.43 128 24 14 1.31 Short courses 8 27 26 2.29 3 10 5 2.11 11 38 31 2.25 Evening series 11 38 22 2.16 0 4 6 2.60a 11 42 29 2.20 Travelling consult. 3 25 20 2.35 7 9 4 1.85 10 34 25 2.21 Distance Systems Audio tapes 2 8 7 2.56 0 2 7 2.78 2 10 24 2.61 Educational t.v. 4 9 22 2.51 4 5 7 2.18 8 15 29 2.40 Educational radio 0 1 1 2.50 0 0 0 0.00 0 1 1 2.50 Correspondence 1 2 6 2.55 0 0 3 3.00 1 2 9 2.67 ^ a u = -.17 p < .02 102 the s k e p t i c i s m of the respondents that such systems would be i n t r o d u c e d f o r c o n t i n u i n g education purposes i n B r i t i s h Columbia. Because of the a v a i l a b i l i t y of e d u c a t i o n a l t e l e v i s i o n with the i n t r o d u c t i o n of the Knowledge Network, an item s p e c i f i c a l l y r e l a t e d to t o p i c s to be d e l i v e r e d v i a t e l e v i s i o n was i n c l u d e d i n the study. F o r t y - f i v e percent of the sample favored programs r e l a t e d to o c c u p a t i o n a l therapy s k i l l s , 27.3% to c l i n i c a l c o n d i t i o n s , 14% to p r o f e s s i o n a l i s s u e s , and 13.4% to b a s i c and a p p l i e d s c i e n c e s . Although the r e s u l t s i n d i c a t e major d i f f e r e n c e s i n the p r e f e r e n c e s of t o p i c , which would be v a l u a b l e in program planni n g , -because of the marginal preference by t h e r a p i s t s f o r t e l e v i s o n as a d e l i v e r y system, the i n f o r m a t i o n i s of q u e s t i o n a b l e v a l u e . T e s t s of Hypotheses The hypotheses examined in t h i s study focused on d i f f e r e n c e s i n p e r c e p t i o n s of c o n t i n u i n g education as a r e s u l t of p r o f e s s i o n a l r o l e and geographic l o c a t i o n . These d i f f e r e n c e s were c o n s i d e r e d in r e l a t i o n to three program pl a n n i n g v a r i a b l e s l e a r n i n g needs, p e r c e i v e d b a r r i e r s to p a r t i c i p a t i o n , and p r e f e r r e d d e l i v e r y systems. The p<.05 l e v e l of s i g n i f i c a n c e was maintained throughout the t e s t i n g of the hypotheses. Hypothesis 1 s t a t e d : There w i l l be a s i g n i f i c a n t d i f f e r e n c e in the p e r c e p t i o n of c l i n i c a l t h e r a p i s t s ' l e a r n i n g needs between c l i n i c a l t h e r a p i s t s and s u p e r v i sory t h e r a p i s t s . 1 03 A comparison of p e r c e p t i o n of c l i n i c a l t h e r a p i s t s ' l e a r n i n g needs held by c l i n i c a l and s u p e r v i s o r y t h e r a p i s t s was c a r r i e d out on the 30 competency areas s t u d i e d and on the three c a t e g o r i e s of competency: e v a l u a t i o n , t h e r a p e u t i c procedure, and u t i l i z i n g t h e r a p e u t i c equipment and m a t e r i a l s . A comparison of the means of the i n d i v i d u a l competencies r e v e a l e d only one competency i n which the d i f f e r e n c e between the t h e r a p i s t groups was s i g n i f i c a n t , apply sensory based t h e r a p i e s to develop p e r c e p t u a l motor s k i l l s ( t=2.03, df=17 5, p<.04). When compared, the means of the three c a t e g o r i e s of competencies showed no s i g n i f i c a n t d i f f e r e n c e s between c l i n i c a l and s u p e r v i s o r y t h e r a p i s t s . Based on these r e s u l t s , Hypothesis 1 was r e j e c t e d . Hypothesis 2 s t a t e d : There w i l l be s i g n i f i c a n t d i f f e r e n c e s i n ident i f i c a t ion of b a r r i e r s to p a r t i c i p a t i o n between c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s . D i f f e r e n c e s in p e r c e i v e d b a r r i e r s were assessed by comparing the two groups of t h e r a p i s t s i n each of the e i g h t b a r r i e r s s t u d i e d . Comparision of the Ke n d a l l Tau f o r ranked data r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s . The two c a t e g o r i e s of b a r r i e r s to p a r t i c i p a t i o n , s i t u a t i o n a l and i n s t i t u t i o n a l , were a l s o compared. Using a Chi Square, no s i g n i f i c a n t d i f f e r e n c e s were found between the two groups. Based on these r e s u l t s , Hypothesis 2 was r e j e c t e d . Hypothesis 3 s t a t e d : There w i l l be a s i g n i f i c a n t d i f f e r e n c e i n the p e r c e p t i o n of d e l i v e r y systems p r e f e r r e d by c l i n i c a l t h e r a p i s t s h e l d by c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s . 104 A comparison of the p r e f e r r e d d e l i v e r y systems for the two groups of t h e r a p i s t s was conducted both on the e i g h t i n d i v i d u a l examples of d e l i v e r y systems and on the two l a r g e r c a t e g o r i e s of systems, d i r e c t and d i s t a n c e systems. A comparison using K e n d a l l ' s Tau for ranked data r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e between the groups in the e i g h t systems s t u d i e d . A Chi Square comparing the d i f f e r e n c e s i n p r e f erence fo r d i r e c t and d i s t a n c e systems a l s o r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s . Based upon these r e s u l t s , Hypothesis 3 was r e j e c t e d . Hypothesis 4 s t a t e d : There w i l l be s i g n i f i c a n t d i f ferences in the l e a r n i n g needs ident i f i e d by r u r a l c l i n i c a l t h e r a p i s t s and urban c l i n i c a l t h e r a p i s t s . A comparison of the l e a r n i n g needs was conducted both on the 30 i n d i v i d u a l competency areas i n v e s t i g a t e d as w e l l as the three c a t e g o r i e s of competencies, e v a l u a t i o n , t h e r a p e u t i c procedure, and u t i l i z i n g t h e r a p e u t i c equipment and m a t e r i a l s . An a n a l y s i s of the i n d i v i d u a l competencies r e v e a l e d that i n two competency areas l e a r n i n g needs were s i g n i f i c a n t l y d i f f e r e n t between the two groups of t h e r a p i s t s (employing socio-drama technique t = - 1 .99 df = 1 36 p< . 0-5 , employ r e a l i t y o r i e n t a t i o n t = - 2.15 df=l36 p<.03). In both cases the needs were higher among r u r a l t h e r a p i s t s . A comparison of l e a r n i n g needs in the three competency c a t e g o r i e s r e v e a l s no s i g n i f i c a n t d i f f e r e n c e s between the groups. Based on these r e s u l t s , Hypothesis 4 was r e j e c t e d with c o n s i d e r a t i o n of the two competency areas that were s t a t i s t i c a l l y s i g n i f i c a n t . Hypothesis 5 s t a t e d : r u r a l c l i n i c a l t h e r a p i s t s w i l l have a s i g n i f i c a n t l y higher estimate of l e a r n i n g needs than do urban 105 c l i n i c a l t h e r a p i s t s . A comparison of the summed need estimates of the sample using T-Tests to analyze d i f f e r e n c e s i n the means re v e a l e d no s i g n i f i c a n t d i f f e r e n c e s between the general statement of need expressed by r u r a l and urban t h e r a p i s t s . Based on these r e s u l t s , Hypothesis 5 was r e j e c t e d . Hypothesis 6 s t a t e d : There w i l l be a s i g n i f i c a n t d i f ference in barr i e r s to part i c i p a t ion ident i f i e d by r u r a l c l i n i c a l t h e r a p i s t s and urban c l i n i c a l t h e r a p i s t s . A comparison of p e r c e i v e d b a r r i e r s was conducted on both the eight b a r r i e r s i n v e s t i g a t e d i n t h i s study and the two c a t e g o r i e s proposed, s i t u a t i o n a l b a r r i e r s and i n s t i t u t i o n a l b a r r i e r s . The a n a l y s i s of the i n d i v i d u a l b a r r i e r s ' using K e n d a l l ' s Tau f o r ranked data r e v e a l e d s i g n i f i c a n t d i f f e r e n c e s between the groups i n f i v e b a r r i e r s . Family r e s p o n s i b i l t y (Tau=.l4 p<.05) and d i s t a n c e (Tau=.49 p<.02) were s i g n i f i c a n t l y higher among r u r a l t h e r a p i s t s while job r e s p o n s i b i l i t y (Tau=-.20 p<.007), l a c k of time (Tau=-.30 p<.003), and inconvenient schedule (Tau=-.16 p<.03) were s i g n i f i c a n t l y higher among the urban t h e r a p i s t . A comparison of s i t u a t i o n a l and i n s t i t u t i o n a l b a r r i e r s r e v e a l s a s i g n i f i c a n t r e l a t i o n s h i p using Chi Square a n a l y s i s (Chi=5.9l df=7 p<.01). Based on these r e s u l t s , Hypothesis 6 was not r e j e c t e d . Hypothesis 7 s t a t e d : there w i l l be a s i g n i f i c a n t d i f f e r e n c e i n d e l i v e r y systems p r e f e r r e d by r u r a l c l i n i c a l t h e r a p i s t s and urban c l i n i c a l t h e r a p i s t s . A comparison of d e l i v e r y systems was conducted both on the 106 eigh t systems i n v e s t i g a t e d in t h i s study and the two c a t e g o r i e s proposed d i r e c t and d i s t a n c e systems. An a n a l y s i s of the i n d i v i d u a l systems using K e n d a l l ' s Tau f o r ranked data r e v e a l s s i g n i f i c a n t d i f f e r e n c e s between the two groups i n only one d e l i v e r y system. Evening s e r i e s were p r e f e r r e d s i g n i f i c a n t l y more by urban t h e r a p i s t s than r u r a l t h e r a p i s t s (Tau=-.17 p< .02). The comparison of d i r e c t and d i s t a n c e systems revealed no s i g n i f i c a n t d i f f e r e n c e s between these two groups. Based on the r e s u l t s , Hypothesis 7 was r e j e c t e d with c o n s i d e r a t i o n of the one s i g n i f i c a n t r e l a t i o n s h i p found. Summary or R e s u l t s The r e s u l t s of the data analyses were presented i n t h i s chapter. The study sample c o n s i s t e d 176 o c c u p a t i o n a l t h e r a p i s t s c u r r e n t l y p r a c t i s i n g i n B r i t i s h Columbia. Of the t o t a l sample, 136 respondents were c l i n i c a l t h e r a p i s t s and 40 were s u p e r v i s o r y t h e r a p i s t s . Seventy-eight percent of the sample were employed i n departments of f i v e or fewer t h e r a p i s t s . The c l i n i c a l t h e r a p i s t s averaged 6.75 years of experience while the s u p e r v i s o r s had a mean of 10.42 years of r e l a t e d e x p e r i e n c e . G e o g r a p h i c a l l y , 139 respondents were c l a s s i f i e d as urban t h e r a p i s t s and 37 as r u r a l t h e r a p i s t s . The r u r a l t h e r a p i s t s had s i g n i f i c a n t l y fewer p r o f e s s i o n a l c o n t a c t s with other t h e r a p i s t s than d i d urban ones. D i f f e r e n c e s i n p e r c e p t i o n of l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n , and p r e f e r r e d d e l i v e r y sytems h e l d by c l i n i c i a n s and s u p e r v i s o r s were minimal. E v a l u a t i o n r e l a t e d competencies were r e p o r t e d to have the highest estimate of l e a r n i n g need 1 07 while the competency area with the fewest t r a i n i n g programs a v a i l a b l e was v o c a t i o n a l assessment and treatment. Both c l i n i c i a n s and s u p e r v i s o r s i d e n t i f i e d f a m i l y r e s p o n s i b i l i t y and lack of time as the major b a r r i e r s to p a r t i c i p a t i o n . Workshops were t h e i r overwhelming p r e f e r e n c e of both ' sub-samples in r e l a t i o n to d e l i v e r y systems. A comparison of the three program planning v a r i a b l e s i n v e s t i g a t e d i n t h i s study r e v e a l e d no s i g n i f i c a n t d i f f e r e n c e s between r u r a l and urban t h e r a p i s t s i n r e l a t i o n to l e a r n i n g needs and d e l i v e r y systems. The r e s u l t s were s i m i l a r to those reported for c l i n i c a l and s u p e r v i s o r y t h e r a p i s t s . The a n a l y s i s of b a r r i e r s to p a r t i c i p a t i o n r e v e a l e d s i g n i f i c a n t d i f f e r e n c e s based on geographic l o c a t i o n of the t h e r a p i s t ; r u r a l t h e r a p i s t s more often i d e n t i f i e d t r a n s p o r t a t i o n and d i s t a n c e and urban t h e r a p i s t s r e p o r t e d the major b a r r i e r s to be inconvenient schedule and f a m i l y r e s p o n s i b i l t y . Although the r e s u l t s d i d not support many of the hypothesized r e l a t i o n s h i p s between the sub-samples, v a l u a b l e program p l a n n i n g i n f o r m a t i o n was gained from the study which w i l l have i m p l i c a t i o n s f o r both long and short term pla n n i n g of c o n t i n u i n g education o p p o r t u n i t i e s f o r t h e r a p i s t s i n B r i t i s h Columbia. 108 CHAPTER FIVE DISCUSSION AND CONCLUSIONS The primary purpose of t h i s study was to examine the r e l a t i o n s h i p s between p r o f e s s i o n a l r o l e and geographic l o c a t i o n of o c c u p a t i o n a l t h e r a p i s t s and three program planning v a r i a b l e s : l e a r n i n g needs, b a r r i e r s to p a r t i c i p a t i o n , and p r e f e r r e d d e l i v e r y systems. A second purpose was to gather i n f o r m a t i o n to a s s i s t i n the design of c o n t i n u i n g education o p p o r t u n i t i e s f o r c l i n i c a l t h e r a p i s t s i n B r i t i s h Columbia. The r e s u l t s of the study re v e a l e d no s i g n i f i c a n t d i f f e r e n c e s in the p e r c e p t i o n of c l i n i c a l t h e r a p i s t s ' l e a r n i n g needs he l d by c l i n i c a l and s u p e r v i s o r y t h e r a p i s t s or i n p e r c e i v e d l e a r n i n g needs between urban and r u r a l t h e r a p i s t s . E v a l u a t i o n - r e l a t e d competencies were i d e n t i f i e d as being the areas of g r e a t e s t need- notably p e r c e p t u a l , c o g n i t i v e , and sensory e v a l u a t i o n . The assessment of the a v a i l a b i l i t y of programs in these areas confirmed that o p p o r t u n i t i e s f o r c o n t i n u i n g education are l i m i t e d . In r e l a t i o n to b a r r i e r s to p a r t i c i p a t i o n , although d i f f e r e n c e s in p e r c e p t i o n h e l d by c l i n i c i a n s and s u p e r v i s o r s were not found to be s i g n i f i c a n t , d i f f e r e n c e s between urban and r u r a l t h e r a p i s t s were s t a t i s t i c a l l y s i g n i f i c a n t on f i v e of the e i g h t b a r r i e r s s t u d i e d . Family r e s p o n s i b i l i t y and d i s t a n c e were s i g n i f i c a n t l y higher among r u r a l t h e r a p i s t s while urban t h e r a p i s t s more o f t e n i d e n t i f i e d job r e s p o n s i b i l i t i e s , time, and 109 inconvenient scheduling as b a r r i e r s to p a r t i c i p a t i o n i n c o n t i n u i n g education programs. Workshops were the overwhelming pr e f e r e n c e of a l l subsamples in r e l a t i o n to d e l i v e r y systems. The a n a l y s i s of p r e f e r r e d d e l i v e r y systems r e v e a l e d no d i f f e r e n c e s between s u p e r v i s o r s and c l i n i c i a n s . Evening s e r i e s were p r e f e r r e d s i g n i f i c a n t l y more often by urban than r u r a l t h e r a p i s t s . T h i s study provided i n f o r m a t i o n which i s h i g h l y r e l e v a n t to the p r o v i s i o n of c o n t i n u i n g education f o r t h e r a p i s t s i n B r i t i s h Columbia. A p r i o r i z e d l i s t of competency areas was i d e n t i f i e d p e r m i t t i n g immediate and long term p l a n n i n g . As w e l l , support f o r the most f r e q u e n t l y used d e l i v e r y system was r e c e i v e d along with i n f o r m a t i o n upon which to base d e c i s i o n s regarding the i n t r o d u c t i o n of newer ones. Although s i t u a t i o n a l b a r r i e r s were i d e n t i f i e d more often by t h e r a p i s t s , they are o f t e n beyond the c o n t r o l of the planner. A f i n d i n g which has more d i r e c t i m p l i c a t i o n s i s that lack of a p p r o p r i a t e programs was reported as a major i n s t i t u t i o n a l b a r r i e r . P r o f e s s i o n a l Role and C o n t i n u i n g Education P r o f e s s i o n a l r o l e was examined in t h i s study as i t r e l a t e d to decision-making in the c o n t i n u i n g education program p l a n n i n g p r o c e s s . I t was hypothesized that c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s would have d i f f e r e n t p e r c e p t i o n s of the needs and p r e f e r e n c e s of c l i n i c i a n s . T h i s problem was focused on because of the tendency f o r program planners i n o c c u p a t i o n a l therapy to c o n s u l t s u p e r v i s o r s about the c o n t i n u i n g education 110 needs and pre f e r e n c e s of t h e i r s t a f f r a t h e r than going d i r e c t l y to r e p r e s e n t a t i v e s of c l i n i c a l t h e r a p i s t s . The r e s u l t s suggest that B r i t i s h Columbian s u p e r v i s o r s and c l i n i c i a n s are f a i r l y s i m i l a r i n t h e i r p e r c e p t i o n s i n the three v a r i a b l e s s t u d i e d . The e x p l a n a t i o n f o r the s i m i l a r i t y of p e r c e p t i o n i s l i k e l y that the m a j o r i t y of s u p e r v i s o r y t h e r a p i s t s sampled are r e s p o n s i b l e for only a small number of s t a f f . Close contact with s t a f f would enable the s u p e r v i s o r y t h e r a p i s t s to be more aware of t h e i r s t a f f ' s p e r c e p t i o n s in these areas. In a d d i t i o n , the s i m i l a r i t y of the groups i n regard to experience may have l e d to t h e i r having s i m i l a r p e r c e p t i o n s . Learning Needs R e s u l t s of t h i s study suggest that there are no s t a t i s t i c a l l y s i g n i f i c a n t d i f f e r e n c e s between the s e l f - p e r c e p t i o n s of c l i n i c a l t h e r a p i s t s and the p e r c e p t i o n s of t h e i r s u p e r v i s o r s i n the i d e n t i f i c a t i o n of competency areas i n which l e a r n i n g needs are high. In c o n t r a s t , r e s u l t s presented in the l i t e r a t u r e suggest that d i f f e r e n c e s i n p e r c e p t i o n s e x i s t and a t t r i b u t e these d i f f e r e n c e s , i n p a r t , to the g r e a t e r amount of experience the s u p e r v i s o r has had in the f i e l d of h e a l t h care. Although t h i s study d i d r e v e a l a mean d i f f e r e n c e of 3.5 years between the groups i t was not found to be s i g n i f i c a n t . The s i m i l a r i t y of years of experience between the groups i s one e x p l a n a t i o n f o r the c o n s i s t e n c y of p e r c e p t i o n of l e a r n i n g need. If p e r c e p t i o n s d i f f e r as a r e s u l t of i n c r e a s i n g years of p r a c t i s e and exposure to the h e a l t h care f i e l d , one would expect that i f c l i n i c i a n s and s u p e r v i s o r s have comparable amounts of 111 experience, d i f f e r e n c e s i n p e r c e p t i o n s of l e a r n i n g need would be minimal as was the case i n t h i s study. Examining the l i t e r a t u r e upon which the hypothesized r e l a t i o n s h i p was based i s one method of e x p l a i n i n g the r e s u l t s of the study. The m a j o r i t y of supporting l i t e r a t u r e was drawn from the f i e l d of n u r s i n g . Although much of the philosophy and many p r a c t i s e s are s i m i l a r in o c c u p a t i o n a l therapy and n u r s i n g , the numbers that are i n v o l v e d i n each p r o f e s s i o n are n o t a b l y d i f f e r e n t . In B r i t i s h Columbia, the R e g i s t e r e d Nurses A s s o c i a t i o n has approxiamtely 22,000 members while the B r i t i s h Columbia S o c i e t y of O c c u p a t i o n a l T h e r a p i s t s has approximately 300. Although t h i s d i f f e r e n c e may not be as marked in a l l l o c a t i o n s , i t i s p o s s i b l e that d i f f e r e n c e s i n e d u c a t i o n a l background, types of employment s i t u a t i o n s , and s t r a t i f i c a t i o n of the p r o f e s s i o n a l r o l e may be greater among nurses than t h e r a p i s t s . These d i f f e r e n c e s c o u l d account for the r e s u l t s that have been found in s t u d i e s i n v e s t i g a t i n g d i f f e r e n c e s i n p e r c e p t i o n of l e a r n i n g needs. As mentioned in Chapter Four, t h e r a p i s t s may be c o n s i d e r e d r e l a t i v e l y homogeneous i n work experience and e d u c a t i o n a l background. An a d d i t i o n a l d i f f e r e n c e between these two groups i s the d i f f e r e n c e i n t r a i n i n g of s u p e r v i s o r s ; t h i s would l e a d to d i f f e r e n c e s i n t h e i r p e r c e p t i o n s . S u p e r v i s o r s i n o c c c u p a t i o n a l therapy f r e q u e n t l y o b t a i n t h e i r p o s i t i o n s through accumulating a number of years experience i n one l o c a t i o n or r e l a t e d s p e c i a l i t y a r e a s . Although t h i s i s o f t e n the case with nursing s u p e r v i s o r s , the number of graduate programs in nursing and s u p e r v i s o r t r a i n i n g courses i s f a r g r e a t e r than that a v a i l a b l e to the 1 1 2 t h e r a p i s t . S u p e r v i s o r s i n n u r s i n g then may have d i f f e r e n t e d u c a t i o n a l backgrounds and thus d i f f e r e n t p e r c e p t i o n s of t h e i r s t a f f than would s u p e r v i s o r y t h e r a p i s t s . The s i m i l a r i t y of the l e a r n i n g needs estimate may a l s o be accounted fo r by the s i z e of the s t a f f f o r which s u p e r v i s o r y t h e r a p i s t s are r e s p o n s i b l e . The r e s u l t s of t h i s study show that 78% of the respondents were employed in departments of f i v e t h e r a p i s t s or l e s s . The small s i z e of the departments would allow s u p e r v i s o r s b e t t e r access to the p e r c e p t i o n s of t h e i r s t a f f i n a number of p r o f e s s i o n a l i s s u e s i n c l u d i n g the i d e n t i f i c a t i o n of l e a r n i n g need. The f a m i l i a r i t y of the s u p e r v i s o r s with the l e v e l of competence of t h e i r c l i n i c i a n s and the o p p o r t u n i t y for e v a l u a t i o n and feedback on an informal b a s i s would c e r t a i n l y have c o n t r i b u t e d to the s i m i l a r i t y of p e r c e p t i o n s based on need assessment u s i n g competency statements. No s p e c i f i c p a t t e r n s or trends i n i d e n t i f i c a t i o n of l e a r n i n g needs between the subsamples were r e v e a l e d . S t u d i e s r e p o r t e d i n Chapter Two suggested that c l i n i c a l t h e r a p i s t s would rank p r a c t i c a l , "how t o " competencies higher than t h e i r s u p e r v i s o r s would p e r c e i v e them as ranking these competencies. The emphasis of t h i s assessment t o o l on c l i n i c a l s k i l l s would have prevented such a trend from o c c u r i n g i n t h i s study. E v a l u a t i o n r e l a t e d competencies were repo r t e d by both c l i n i c i a n s and s u p e r v i s o r s as the top ranked l e a r n i n g need. A p o s s i b l e e x p l a n a t i o n of t h i s f i n d i n g i s that treatment approach and method are dependent upon accurate e v a l u a t i o n of the c l i e n t . The emphasis on c o g n i t i v e and perceptual-motor e v a l u a t i o n 1 1 3 r e f l e c t s the tendency for undergraduate t r a i n i n g to s t r e s s p h y s i c a l and f u n c t i o n a l types of e v a l u a t i o n at the expense of other assessment procedures. In a d d i t i o n , new treatment approaches to n e u r o l o g i c a l d y s f u n c t i o n , the n e u r o p h y s i o l o g i c a l approach to the brain-damaged i n d i v i d u a l , f o r example, would n e c e s s i t a t e updating or expanding knowledge of these types of e v a l u a t i o n s . These new treatment models are o f t e n accompanied by f o r m a l i z e d or norm-referenced assessment t o o l s which n e c e s s i t a t e the t h e r a p i s t r e c e i v i n g some type of t r a i n i n g p r i o r to t h e i r use. A comparison of the a v a i l a b i l t y of t r a i n i n g i n each of the competency areas and the l e a r n i n g needs r e v e a l s that a number of areas were reported having both high l e a r n i n g needs and s u f f i c i e n t t r a i n i n g o p p o r t u n i t i e s a v a i l a b l e . E v a l u a t i o n of perceptual-motor s k i l l s and sensory f u n c t i o n are two examples which ranked in the top f i v e l e a r n i n g needs and a l s o h i g h l y among competencies where programs were a v a i l a b l e . T h i s i n d i c a t e s that although a high l e a r n i n g need e x i s t s , t h e r a p i s t s are not t a k i n g advantage of the p l e n t i f u l programs f o r a number of reasons. B a r r i e r s to p a r t i c i p a t i o n may be g r e a t e r than t h e i r l e a r n i n g need, or the focus of the program may not be a p p r o p r i a t e . For i n s t a n c e , they may have i n s u f f i c e n t t h e o r e t i c a l content. Another e x p l a n a t i o n i s that the present programs are too few i n number. Many of the n e u r o l o g i c a l l y o r i e n t e d programs have l i m i t e d enrollment and use resource people who are not r e a d i l y a v a i l a b l e to repeat the programs. Another p o s s i b i l i t y i s that d e s p i t e the a v a i l a b i l i t y of programs, the competency areas change s o . q u i c k l y that a need always e x i s t s . 1 14 Barr i e r s to Part i c i p a t ion The r e s u l t s of t h i s study suggest that t h e r a p i s t s c o n s i d e r f a m i l y r e s p o n s i b i l i t y , lack of a p p r o p r i a t e programs, and lack of time as the major b a r r i e r s to p a r t i c i p a t i o n . T h i s supports the l i t e r a t u r e suggesting that s i t u a t i o n a l b a r r i e r s are the g r e a t e s t b a r r i e r s to a d u l t l e a r n i n g . It was hypothesized that d i f f e r e n c e s in p e r c e p t i o n of c l i n i c i a n s ' b a r r i e r s to p a r t i c i p a t i o n would be hel d by s u p e r v i s o r s and c l i n i c i a n s based on the s u p e r v i s o r s having a gre a t e r committment to c o n t i n u i n g education which would be p r o j e c t e d onto t h e i r s t a f f . I t was suggested that an attempt to reduce some- of the s i t u a t i o n a l b a r r i e r s would accompany a high degree of committment by the t h e r a p i s t s . D i f f e r e n c e s e x i s t e d between the two groups, s u p e r v i s o r s p e r c e i v i n g lack of a p p r o p r i a t e programs as a major b a r r i e r and c l i n i c i a n s p e r c e i v i n g job r e s p o n s i b i l t y and c o s t as g r e a t e r d e t e r r e n t s to p a r t i c i p a t i o n . These d i f f e r e n c e s , however were not s t a t i s t i c a l l y s i g n i f i c a n t . The s i m i l a r i t y of p e r c e p t i o n s between these two groups may be a r e s u l t of the small s t a f f s i z e a s s o c i a t e d with the m a j o r i t y of o c c u p a t i o n a l therapy departments. A small s t a f f - s u p e r v i s o r r a t i o c r e a t e s the p o t e n t i a l f o r more i n t e r a c t i o n and p o t e n t i a l awareness by the s u p e r v i s o r s of the personal demands made on the time of the c l i n i c a l t h e r a p i s t . A c l o s e r r e l a t i o n s h i p with the s t a f f would be r e f l e c t e d in the s u p e r v i s o r ' s a b i l i t y to p e r c e i v e the s i t u a t i o n a l b a r r i e r s that t h e i r c l i n i c a l s t a f f i d e n t i f i e d . The p r o p o s i t i o n that s u p e r v i s o r y t h e r a p i s t s would have a higher committment to a t t e n d i n g c o n t i n u i n g education programs and expect t h e i r s t a f f to have the same amount of commitment was 115 not supported by the r e s u l t s of t h i s study. Although not s t a t i s t i c a l l y s i g n i f i c a n t , a trend towards d i f f e r e n c e s i n p e r c e p t i o n i s suggested by t h i s study. C l i n i c a l t h e r a p i s t s ranking f a m i l y r e s p o n s i b i l i t y , job r e s p o n s i b i l t y , and c o s t as the top three b a r r i e r s c l e a r l y i n d i c a t e the i d e n t i f i c a t i o n of s i t u a t i o n a l b a r r i e r s . T h i s can be understood from the p o i n t of view of a t h e r a p i s t with l i m i t e d experience; these b a r r i e r s would be c r e a t e d by l e a r n i n g new job demands and b a l a n c i n g these with the demands of p r i v a t e l i f e , i n c l u d i n g the f i n a n c i a l i n s e c u r i t y of the f i r s t few years of employment. The s u p e r v i s o r ' s group in t h i s sample repo r t e d that lack of a p p r o p r i a t e programs was a major concern of t h e i r s t a f f , one which would c l e a r l y be more r e l e v a n t to the person with more exper i e n c e . T h i s response may be a r e s u l t of the s u p e r v i s o r s ' awareness of the o p p o r t u n i t i e s of other p r o f e s s i o n s i n the h e a l t h care f i e l d . R e a l i z i n g that the programs a v a i l a b l e to the o c c u p a t i o n a l t h e r a p i s t are l i m i t e d i n comparison, i d e n t i f i c a t i o n of t h i s b a r r i e r would be l o g i c a l . Another i n t e r p r e t a t i o n of t h i s f i n d i n g i s that c l i n i c a l t h e r a p i s t s who r e p o r t a lack of a p p r o p r i a t e programs as a major b a r r i e r , may be attempting to o f f e r an a c c e p t a b l e excuse f o r not a t t e n d i n g programs while masking other l e s s p r o f e s s i o n a l reasons, such as d i s i n t e r e s t . D e l i v e r y Systems D e l i v e r y systems were c o n s i d e r e d i n t h i s study p r i m a r i l y as a method of e v a l u a t i n g the system which i s predominant at the present time, the workshop. The r e s u l t s of the study support the c u r r e n t tendency to use the one or two day workshop as the 1 16 v e h i c l e f o r c o n t i n u i n g education programs in the f i e l d of o c c u p a t i o n a l therapy. The hypothesized d i f f e r e n c e s i n p e r c e p t i o n h e l d by c l i n i c i a n s and s u p e r v i s o r s was based on the p r o p o s i t i o n that because of t h e i r experience, s u p e r v i s o r s would be more f a m i l i a r with workshops and would p r o j e c t t h i s p r e f e rence onto t h e i r s t a f f . C l i n i c a l t h e r a p i s t s , on the other hand, were thought to have r e c e i v e d more exposure to a l t e r n a t i v e d e l i v e r y systems. The r e s u l t s of the study d i d not support d i f f e r e n c e s a c c o r d i n g to p r o f e s s i o n a l - r o l e nor were s i g n i f i c a n t d i f f e r e n c e s found between the years of experience of the two groups. No support was given to the c o n t e n t i o n that the most r e c e n t l y graduated t h e r a p i s t s are more aware of a l t e r n a t e d e l i v e r y systems and would report them as p r e f e r e n c e s ; the r e s u l t s suggest that the opposite may be t r u e . I t i s p o s s i b l e that c l i n i c a l t h e r a p i s t s ' recent expereince with the l e c t u r e and lab methods of t e a c h i n g t r a d i t i o n a l y used i n u n i v e r s i t i i e s would support the preference f o r workshops found i n t h i s study. F a m i l i a r i t y with the workshop and short course systems was l i k e l y the p r i n c i p l e in o p e r a t i o n i n t h i s study. T y p i c a l l y respondents w i l l choose an item or a l t e r n a t i v e which they are f a m i l i a r with, even i f not i n t o t a l agreement with i t , over an unknown a l t e r n a t i v e (Payton, 1979). The lack of examples of other systems in the f i e l d of r e h a b i l i t a t i o n w o u l d ' l i k e l y have b i a s e d t h e r a p i s t s toward an a l t e r n a t i v e with which they had experience. Other than the short course and the very o c c a s i o n a l evening s e r i e s , exposure to other d e l i v e r y systems has been m i n i ma1. 1 17 The s i m i l a r i t y of responses between these two groups may a l s o r e f l e c t the methods used in undergraduate t r a i n i n g . I t i s l a r g e l y c a r r i e d out using d i r e c t methods, l e c t u r e and small group i n t e r a c t i o n , which the c u r r e n t c o n t i n u i n g education programs are p a t t e r n e d a f t e r . T h e r a p i s t s may be predisposed to r e p o r t a p r e f e r e n c e f o r c o n t i n u i n g education programs using these same methods unless they had o p p o r t u n i t y to p a r t i c i p a t e i n other d e l i v e r y systems. In B r i t i s h Columbia these o p p o r t u n i t i e s have been minimal. One of the c h a r a c t e r i s t i c s of most of the d i r e c t systems i s that they are f i x e d in time and p l a c e and that t h e r a p i s t s must arrange work and f a m i l y r e s p o n s i b i l i t i e s around a t t e n d i n g these. Because of the predominance of s i t u a t i o n a l b a r r i e r s i d e n t i f i e d by c l i n i c a l t h e r a p i s t s , one would expect that they would have p r e f e r r e d d i s t a n c e types of systems which would allow them more f l e x i b i l i t y and a v o i d some of the s i t u a t i o n a l b a r r i e r s . For i n s t a n c e , the c a p a c i t y to p a r t i c i p a t e i n e d u c a t i o n a l t e l e v i s i o n and r a d i o i s t y p i c a l l y a v a i l a b l e i n the home. If programs were o f f e r e d , t h i s d e l i v e r y system might reduce at l e a s t some of the f a m i l y and d i s t a n c e problems. Correspondence and audio tapes reduce problems a s s o c i a t e d with s c h e d u l i n g and the o b l i g a t i o n to leave the home in order to p a r t i c i p a t e i n c o n t i n u i n g e d u c a t i o n . The r e s u l t s i n d i c a t e that t h e r a p i s t s must be g a i n i n g b e n e f i t s by a t t e n d i n g workshops and short courses which outweigh the b a r r i e r s that are produced. Another e x p l a n a t i o n f o r the c o n s i s t e n c y of r e s u l t s i s that the items on the q u e s t i o n n a i r e may not have been d e f i n e d s u f f i c e n t l y or t h e i r meanings understood. For i n s t a n c e , 1 1 8 t r a v e l l i n g c o n s u l t a n t s were i d e n t i f i e d as the second choice by s u p e r v i s o r s who may have more knowledge of that type of system as compared to i t being ranked f i f t h most p r e f e r r e d by c l i n i c a l t h e r a p i s t s . Ambiguity of meaning may a l s o have been a f a c t o r i n the low ranking of evening s e r i e s , which may have been i n t e r p r e t e d to mean every evening a week f o r s e v e r a l weeks. T h e r a p i s t s may have s e l e c t e d an a l t e r n a t i v e of which they were c e r t a i n of the meaning over one whose d e f i n i t i o n was not c l e a r . It i s i n t e r e s t i n g to note that the preference f o r workshops has not changed i n the seven years between t h i s study and the one conducted by McGregor in 1975. De s p i t e new inn o v a t i o n s in s a t e l l i t e e d u c a t i o n a l systems and a u d i o v i s u a l a i d s , the overwhelming preference f o r workshops was even more pronounced in t h i s study. Geographic Locat ion and Cont i n u i n q Educat ion Geographic l o c a t i o n of the t h e r a p i s t was the second c h a r a c t e r i s t i c c o n s i d e r e d in r e l a t i o n to program planning in c o n t i n u i n g education. The c u r r e n t s t a t e of programming i n B r i t i s h Columbia i s that the m a j o r i t y of programs are o f f e r e d in the l a r g e m e t r o p o l i t a n areas, Vancouver or V i c t o r i a . Although t h e r a p i s t s i n o u t l y i n g areas are o f t e n v o c a l about t h e i r need to update s k i l l s and knowledge, f i n a n c i a l c o n s t r a i n t s have made i t d i f f i c u l t to address the needs of those who are g e o g r a p h i c a l l y i s o l a t e d . One of the purposes of t h i s study was to determine i f d i f f e r e n c e s e x i s t i n r e l a t i o n to l o c a t i o n and, i f so, what the s p e c i a l needs were of the r u r a l and urban subgroups. 119 In order to determine i f d i f f e r e n c e s in d a i l y c o n t a c t s with c o l l e a g u e s i n f l u e n c e d the needs and p r e f e r e n c e s of t h e r a p i s t s as was suggested in the review of the l i t e r a t u r e , the frequency of p r o f e s s i o n a l c o n t a c t s was s o l i c i t e d from respondents. Although there were s i g n i f i c a n t d i f f e r e n c e s between the urban and r u r a l c l i n i c a l t h e r a p i s t s i n r e l a t i o n to p r o f e s s i o n a l c o n t a c t s , major d i f f e r e n c e s in l e a r n i n g needs and p r e f e r r e d d e l i v e r y systems were not i d e n t i f i e d . The r e s u l t s d i d show s i g n i f i c a n t d i f f e r e n c e s i n b a r r i e r s to p a r t i c i p a t i o n between the two groups of t h e r a p i s t s , but, due to t h e i r nature, are of l i t t l e p r a c t i c a l value to the planner. Learning Needs Two aspects of l e a r n i n g needs were examined in r e l a t i o n to geographic l o c a t i o n . The f i r s t of these addressed whether d i f f e r e n c e s i n need estimate f o r i n d i v i d u a l competency area e x i s t e d . The second d e a l t with d i f f e r e n c e s in o v e r a l l need f o r c o n t i n u i n g education between r u r a l and urban t h e r a p i s t s . The p a t t e r n that emerges from the a n a l y s i s of the data emphasizes e v a l u a t i o n as the area of highest l e a r n i n g need, notably i n the non-motor r e l a t e d areas. Urban and r u r a l t h e r a p i s t s r e p o r t e d the same competency area f o r the f i v e top ranked needs. C o u n s e l l i n g s k i l l s , sensory and p e r c e p t u a l motor e v a l u a t i o n and treatment have higher need estimates than the more t r a d i t i o n a l competency a r e a s , muscle s t r e n g t h e n i n g or energy c o n s e r v a t i o n f o r example. T h i s l i k l e y r e f l e c t s the l a t e s t i n n o v a t i o n s i n the f i e l d of r e h a b i l i t a t i o n , t o p i c s which were 120 p o s s i b l y not i n c l u d e d i n undergraduate t r a i n i n g . The r e s u l t s of the a n a l y s i s of the s p e c i f i c areas of need re v e a l e d only minor d i f f e r e n c e s in the i d e n t i f i c a t i o n of l e a r n i n g needs between r u r a l and urban t h e r a p i s t s . The c o n t e n t i o n that d i f f e r e n c e s would e x i s t was based on the commonly acknowledged assumption that r u r a l t h e r a p i s t s are g e n e r a l i s t s i n p r o f e s s i o n a l p r a c t i s e while urban t h e r a p i s t s more o f t e n become s p e c i a l i s t s i n one f i e l d of h e a l t h c a r e . T h i s tendency i s a r e s u l t of the comparative lack of f a c i l i t i e s i n the r u r a l areas and, t h e r e f o r e , r e h a b i l i t a t i o n s t a f f , which would cre a t e a s i t u a t i o n where the t h e r a p i s t would be i n v o l v e d i n a l l areas of p r a c t i s e . The urban t h e r a p i s t , l i k e l y employed in a l a r g e r , more s p e c i a l i z e d f a c i l i t y would have a narrower focus to p r o f e s s i o n a l p r a c t i c e . The s i m i l a r i t y i n i d e n t i f i c a t i o n of l e a r n i n g needs may be p a r t i a l l y e x p l a i n e d by the b i a s of the assessment t o o l used. The competency statements upon which the t o o l was based were of a 'general nature because of the i n t e n t to have the survey apply to as many t h e r a p i s t s as p o s s i b l e . In attempting to do so, a looseness in the i n t e r p r e t a t i o n of the competency may have oc c u r r e d . Rural t h e r a p i s t s may have taken the competency to have a broad meaning while urban t h e r a p i s t s may have i n t e r p r e t e d them i n . l i g h t of t h e i r s p e c i a l i z e d p r a c t i c e . For example, e v a l u a t i o n of v o c a t i o n a l s k i l l s c o u l d be d e s c r i b i n g both the p r a c t i s e of t a k i n g a v o c a t i o n a l and e d u c a t i o n a l h i s t o r y i n the broad sense and conducting commercial v o c a t i o n a l e x p l o r a t i o n assessment or job s i m u l a t i o n i n a more s p e c i a l i z e d sense. The second aspect of l e a r n i n g needs i n v e s t i g a t e d was the 121 d i f f e r e n c e i n o v e r a l l degree of need expressed by the respondents. A s i n g l e estimate of need was c a l c u l a t e d by t o t a l i n g a l l of the estimates f o r the 30 competencies s t u d i e d . The assumption behind t h i s hypothesis was that because r u r a l t h e r a p i s t s are disadvantaged i n r e l a t i o n to p r o f e s s i o n a l c o n t a c t s and more f o r m a l i z e d types of c o n t i n u i n g education, they would e x h i b i t -a g r e a t e r o v e r a l l need than t h e i r urban c o l l e a g u e s . Despite the f a c t that there were s i g n i f i c a n t d i f f e r e n c e s between the numbers of p r o f e s s i o n a l c o n t a c t s experienced by r u r a l and urban t h e r a p i s t s , there was no s i g n i f i c a n t d i f f e r e n c e between the o v e r a l l need e s t i m a t e s . One p o s s i b l e e x p l a n a t i o n f o r t h i s r e s u l t i s the f i n a n c i a l a s s i s t a n c e a v a i l a b l e for h e a l t h care workers in non-metropolitan areas to t r a v e l to l a r g e r c e n t e r s to attend c o n t i n u i n g education programs. T h i s funding i s one method that has been introduced to decrease the i s o l a t i o n of r u r a l h e a l t h care workers. The r u r a l t h e r a p i s t s i n t h i s study may have been b e n e f i t t i n g from the i n c r e a s e d o p p o r t u n i t y to a t t e n d programs that the s p e c i a l funding has allowed and thus not p e r c e i v e d themselves i n greater need than urban t h e r a p i s t s who have ready access to o p p o r t u n i t i e s . Another p o s s i b l e e x p l a n a t i o n f o r t h i s r e s u l t i s that r u r a l t h e r a p i s t s make a g r e a t e r e f f o r t to meet t h e i r l e a r n i n g needs because of t h e i r l o c a t i o n . Aware of t h e i r l i m i t e d o p p o r t u n i t i e s f o r p r o f e s s i o n a l exchange, t h e r a p i s t s may spend g r e a t e r time and f i n a n c i a l resources to ensure that they are up to date i n t h e i r p r o f e s s i o n a l s k i l l s and knowledge. Related to t h i s i s the p o s s i b l i t y that r u r a l t h e r a p i s t s are a c t i v e i n a l t e r n a t i v e forms 122 of c o n t i n u i n g education not i n v e s t i g a t e d i n t h i s study. Independent study programs using i n t e r l i b r a r y l o a n , j o u r n a l exchange programs, and i n f o r m a l exchanges with other h e a l t h care workers are methods through which l e a r n i n g needs c o u l d be met i n o u t l y i n g areas. The r e s u l t s of t h i s study must be c o n s i d e r e d i n r e l a t i o n to a l i m i t e d d e f i n i t i o n of c o n t i n u i n g education and cannot be a p p l i e d to a l l methods of continued l e a r n i n g . The general nature of the competency statements i n v e s t i g a t e d in t h i s study i s another e x p l a n a t i o n f o r the r e s u l t s . Because r u r a l t h e r a p i s t s ' are t y p i c a l l y c o n sidered g e n e r a l i s t s , the areas surveyed would more l i k e l y p a r a l l e l the r u r a l t h e r a p i s t s p r a c t i s e than that of the urban s p e c i a l i s t . The competencies, then, may not have been c o n s i d e r e d as r e l e v a n t to the p r a c t i s e of the urban t h e r a p i s t s r e s u l t i n g i n a lower score being c a l c u l a t e d i n t o the estimate of need. A comparison of the t o t a l mean relevance of the competency statements of the two groups of t h e r a p i s t s i n d i c a t e d that the r u r a l t h e r a p i s t s r e p o r t e d the competencies more r e l e v a n t to t h e i r p r a c t i s e than d i d urban t h e r a p i s t s , but, t h i s d i f f e r e c e was not found to be s i g n i f i c a n t l y d i f f e r e n t . T h i s may have c o n t r i b u t e d to the u n p r e d i c t e d s i m i l a r i t y between the two groups. The b i a s of the assessment t o o l toward the r u r a l t h e r a p i s t may have minimized the d i f f e r e n c e s i n o v e r a l l need estimate that were expected r e s u l t s of t h i s study. B a r r i e r s to P a r t i c i p a t i o n The r e s u l t s of t h i s study supported the hypothesized d i f f e r e n c e s between urban and r u r a l t h e r a p i s t s i n r e l a t i o n to 123 b a r r i e r s to p a r t i c i p a t i o n in c o n t i n u i n g education programs. Rural t h e r a p i s t s ranked lack of t r a n s p o r a t i o n as the major b a r r i e r , an expected response c o n s i d e r i n g the c u r r e n t s i t u a t i o n in B r i t i s h Columbia where workshops in m e t r o p o l i t a n areas are u s u a l l y the only type of program a v a i l a b l e . Urban t h e r a p i s t s with easy access to programs r e p o r t e d b a r r i e r s r e l a t e d to p e r s o n a l s i t u a t i o n s as reasons for not p a r t i c i p a t i n g i n c o n t i n u i n g education programs. The b a r r i e r s r e p o r t e d by the r u r a l t h e r a p i s t s supports a case f o r s p e c i a l s e r v i c e s f o r t h i s group. The response to p r e f e r r e d d e l i v e r y systems d i s c u s s e d below, however, makes i t d i f f i c u l t f o r the planner to reduce the b a r r i e r s and s t i l l c o n s i d e r the p r e f e r e n c e s of the t h e r a p i s t s . Although i d e n t i f y i n g b a r r i e r s should f a c i l i t a t e p a r t i c i p a t i o n , those re p o r t e d by urban t h e r a p i s t s , f a m i l y r e s p o n s i b i l t y and lack of time, are d i f f i c u l t f o r the planner to address. In some ins t a n c e s planners may reduce b a r r i e r s by changing the schedule, p r o v i d i n g more s p e c i a l i z e d programs, or r e l o c a t i n g the program in an attempt to encourage i n c r e a s e d p a r t i c i p a t i o n . Perhaps by b r i n g i n g the b a r r i e r s to the a t t e n t i o n of the t h e r a p i s t s through completing the q u e s t i o n n a i r e , respondents w i l l at l e a s t be c o nscious of the b a r r i e r s that p e r t a i n to them . Although t h i s i s an i n d i r e c t way of a ddressing the i s s u e , r a i s i n g the l e v e l of awareness through completing a q u e s t i o n n a i r e may reduce b a r r i e r s and f a c i l i t a t e p a r t i c i p a t i o n to some degree. D e l i v e r y Systems One of the most unexpected r e s u l t s of t h i s study was the p r e f e r e n c e of both urban and r u r a l t h e r a p i s t s f o r one of the 124 d i r e c t d e l i v e r y systems, the one or two day workshop. Although r u r a l t h e r a p i s t s i d e n t i f i e d t r a n s p o r t a t i o n and d i s t a n c e as the g r e a t e s t b a r r i e r s to p a r t i c i p a t i o n , they d i d not p r e f e r d e l i v e r y systems which have the p o t e n t i a l to reduce these b a r r i e r s . The r e s u l t s i n d i c a t e that respondents want workshops or short courses arranged in t h e i r l o c a l i t y , which are o f t e n f i n a n c i a l l y p r o h i b i t i v e . S i m i l a r to the e x p l a n a t i o n proposed for the r e s u l t s of the p r e f e r e n c e of d e l i v e r y system by c l i n i c i a n s and s u p e r v i s o r s , f a m i l i a r i t y with the d i r e c t systems compared to the d i s t a n c e systems i s the most l o g i c a l e x p l a n a t i o n f o r the lack of d i f f e r e n c e s between r u r a l and urban t h e r a p i s t s . Although the l i t e r a t u r e r e f l e c t s a general preference by h e a l t h care workers fo r workshops in a l l types of c o n t i n u i n g education, one would have expected more support fo r d i s t a n c e systems by ' r u r a l t h e r a p i s t s on a q u e s t i o n n a i r e which o f f e r e d a number of o p t i o n s . Rural t h e r a p i s t s having l i t t l e or no p r a c t i c a l experience with the d i s t a n c e systems i n c l u d e d i n t h i s study may have re p o r t e d a l t e r n a t i v e s which they have p a r t i c i p a t e d i n p r e v i o u s l y r a t h e r than those they may be i n t e r e s t e d i n but of which they have l i t t l e knowledge. Perhaps some s k e p t i c i s m on the part of the t h e r a p i s t s that these d i s t a n c e systems would a c t u a l l y be i n s t i t u t e d f o r c o n t i n u i n g education purposes i s a l s o r e f l e c t e d i n the r e s u l t s . These r e s u l t s suggest that the b e n e f i t s of d i r e c t systems to r u r a l t h e r a p i s t s outweigh the f i n a n c i a l and time committment that they n e c e s s i t a t e . The o p p o r t u n i t y f o r both p r o f e s s i o n a l and s o c i a l interchange i s one of the well-documented b e n e f i t s of the 125 d i r e c t d e l i v e r y systems (Langerman and Smith, 1980). The data suggesting that the r u r a l t h e r a p i s t has s i g n i f i c a n t l y fewer o p p o r t u n i t i e s fo r p r o f e s s i o n a l c o n t a c t s was supported i n t h i s study, and t h e r e f o r e the p r e f e r e n c e for d i r e c t systems may be an attempt to decrease t h i s p r o f e s s i o n a l i s o l a t i o n . Another advantage of the d i r e c t systems i s that they u s u a l l y provide o p p o r t u n i t y to t r a v e l to a l a r g e r m e t r o p o l i t a n c e n t e r . Rural t h e r a p i s t s may have been i n d i c a t i n g a d e s i r e to t r a v e l to a d i f f e r e n t area or to experience a change in t h e i r usual environments in t h e i r p r e f e r e n c e f o r d i r e c t sytems. One of the major d i f f e r e n c e s between t h i s study and that conducted by McGregor (Note 5) was the r e l a t i v e l y low number of responses to correspondence as a p r e f e r r e d d e l i v e r y system in the present study, l e s s than 3% compared to 24%. T h i s may p a r t i a l l y be due to the f a c t that she s t i p u l a t e d correspondence was f o r c r e d i t , while in t h i s study i t was not s p e c i f i e d . The h e a l thy response to t h i s system in McGregor's study may r e f l e c t the i n t e r e s t i n t h i s system i f some type of academic c r e d i t were a v a i l a b l e . T h i s suggests that the r e s u l t s of t h i s study may have d i f f e r e d had c e r t i f i c a t i o n or c r e d i t accumulation been s p e c i f i e d . T h i s area w i l l be addressed in the i m p l i c a t i o n s of the study. Assessment Tool A secondary purpose of t h i s study was to t e s t a t o o l f o r the assessment of c o n t i n u i n g education needs. With a 126 comprehensive assessment, planners c o u l d be more c o n f i d e n t that the programs they o f f e r r e f l e c t the needs of the p o t e n t i a l p a r t i c i p a n t s . Supporting the need f o r a comprehensive assessment t o o l i s the f a c t that one of the unexpected f i n d i n g s in t h i s study was the response i n d i c a t i n g a lack of a p p r o p r i a t e programs as a major b a r r i e r to p a r t i c i p a t i o n . T h i s c o u l d i n d i c a t e a general l a c k of programs f o r o c c u p a t i o n a l t h e r a p i s t s or that planners are not basing t h e i r d e c i s i o n s on accurate i n f o r m a t i o n thus o f f e r i n g programs of l i t t l e r e l e v a n c e . T r a d i t i o n a l l y , a c h e c k l i s t type of i n t e r e s t survey has been employed to i d e n t i f y areas f o r programming. Although these provide some i n d i c a t i o n of the t h e r a p i s t s ' i n t e r e s t s , according to the d e f i n i t i o n of need as a gap between e x i s t i n g and d e s i r e d knowledge and s k i l l s , l e a r n i n g needs are oft e n not assessed. The instrument used i n t h i s study attempted to overcome the l i m i t a t i o n s of the t r a d i t i o n a l assessment t o o l . Competency statements r a t h e r than s p e c i a l i t y areas or dis e a s e e n t i t i e s were suggested as programming areas i n an attempt to have the t o o l apply to as many t h e r a p i s t s as p o s s i b l e . The need was q u a n t i f i e d by having the respondent s t a t e both d e s i r e d and e x i s t i n g l e v e l s of competetence in the areas suggested and s u b t r a c t i n g the v a l u e s . As a f u r t h e r guide f o r p l a n n e r s , the relevence of each competency area to the p r a c t i s e of o c c u p a t i o n a l therapy was s o l i c i t e d i n order to d i s t i n g u i s h between needs that e x i s t but are not p r e s s i n g in r e l a t i o n to c u r r e n t p r a c t i s e and those that r e q u i r e immediate a t t e n t i o n . T h i s format f o r the assessment t o o l allowed needs to be q u a n t i f i e d which f a c i l i t a t e d comparison among groups and ranking of needs as to importance. 1 27 In reviewing the r e s u l t s of the assessment a bimodal d i s t r i b u t i o n was found with the most frequent responses being 0, or no need e x i s t i n g and 3, i n d i c a t i n g a gap between e x i s t i n g and d e s i r e d competence on an area that i s h i g h l y r e l e v a n t to the p r a c t i s e of o c c u p a t i o n a l therapy. When the means were compared, a l i s t of p r i o r i t y needs was r e v e a l e d , which i s u s e f u l i n r e l a t i o n to supporting short term planning d e c i s i o n s and i n p l a n n i n g f o r programs in the f u t u r e . An o v e r a l l e v a l u a t i o n of the t o o l suggests i t i s of p r a c t i c a l use f o r the planner. In a d d i t i o n to the p r i o r i t y l i s t of l e a r n i n g needs, an i n d i c a t i o n of whether present programs are e f f e c t i v e was provided by comparing l e a r n i n g need and a v a i l a b i l i t y of t r a i n i n g responses. A n a l y z i n g the responses to the relevance of the competency areas to p r a c t i s e gave support to the relevance of the q u e s t i o n n a i r e i t s e l f . The competencies i n c l u d e d i n t h i s t o o l were r e l a t i v e l y general i n nature; a s i m i l a r t o o l f o c u s s i n g on one approach to therapy, p s y c h i a t r y or p h y s i c a l medicine f o r example, may have provided more d e t a i l e d program content information f o r the planner. In e v a l u a t i n g a needs assessment t o o l , the i s s u e of whether the instrument can p r e d i c t p a r t i c i p a t i o n i n r e s u l t a n t programs should be c o n s i d e r e d . In many ins t a n c e s i n d i c a t i n g a need may not be t r a n s l a t e d i n t o a c t u a l p a r t i c i p a t i o n because the b a r r i e r s to p a r t i c i p a t i o n may be s t r o n g e r than the d i s c r e p a n c y i n s k i l l s or knowledge. Because t h i s instrument took i n t o account a number of the component p a r t s of need, and t h e r e f o r e tapped more than an i n t e r e s t , i t may be a b e t t e r i n d i c a t o r of p a r t i c i p a t i o n than many of the t r a d i t i o n a l instruments. The planner however, must 128 be c a u t i o n e d against assuming that needs w i l l d i r e c t l y t r a n s l a t e i n t o attendance at c o n t i n u i n g education programs. L i m i t a t i o n s of Research Design A number of l i m i t a t i o n s e x i s t i n the research design used in the study. In r e l a t i o n to the sampling technique, the comparison between c l i n i c a l t h e r a p i s t s and s u p e r v i s o r y t h e r a p i s t s was made i n a very broad manner in that the s u p e r v i s o r s i n general were compared to a l a r g e group of c l i n i c i a n s . No attempt was made to match the s u p e r v i s o r s ! p e r c e p t i o n s of c o n t i n u i n g education to t h e i r own s t a f f p e r c e p t i o n s . A more r i g o r o u s design would match the two groups in r e l a t i o n to t h e i r work s e t t i n g and thus h o l d a number of f a c t o r s constant. Problems in the wording of the q u e s t i o n n n a i r e may have produced some co n f u s i o n f o r the respondents thereby b i a s i n g the r e s u l t s . Notably in the case where the s u p e r v i s o r s were asked to i n d i c a t e t h e i r p e r c e p t i o n s of t h e i r s t a f f ' s needs, i t i s p o s s i b l e that the s u p e r v i s o r s may have i n d i c a t e d t h e i r own needs and p r e f e r e n c e s at p o i n t s throughout the q u e s t i o n n a i r e . The wording may a l s o have had an e f f e c t on the q u e s t i o n s i n v e s t i g a t i n g b a r r i e r s to p a r t i c i p a t i o n and p r e f e r r e d d e l i v e r y systems i n that only one item was used to tap each of these v a r i a b l e s . There was no o p p o r t u n i t y to v a l i d a t e the respondent's understanding by comparing q u e s t i o n s that tapped s i m i l a r informat i o n . Although comments regarding the q u e s t i o n n n a i r e were welcome 1 29 as i n d i c a t e d i n the c o v e r i n g l e t t e r , only one area was the su b j e c t of a number of comments by respondents. The item r e g a r d i n g the a v a i l a b i l i t y of t r a i n i n g i n the competency area was not s u f f i c e n t l y d e f i n e d a c c o r d i n g to 12 respondents. Questions focussed on whether t r a i n i n g r e f e r r e d s p e c i f i c a l l y to the f i e l d of r e h a b i l i t a t i o n or to other h e a l t h care areas. More p r e c i s e wording would have reduced t h i s problem. Implicat ions C o n t i n u i n g education i s fundamental to the competent p r a c t i s e of o c c u p a t i o n a l therapy. The success of a program i s o f t e n dependent upon the planner's a b i l i t y to assess the needs and p r e f e r e n c e s of the p o t e n t i a l p a r t i c i p a n t s and to respond with r e l e v a n t programs. The t h e r a p i s t ' s l e v e l of m o t i v a t i o n to continue to be i n v o l v e d i n p r o f e s s i o n a l l e a r n i n g i s d i r e c t l y i n f l u e n c e d by the q u a l i t y of the l e a r n i n g experiences they have p a r t i c i p a t e d i n . Th e r e f o r e , one of the purposes of t h i s study was to gather planning i n f o r m a t i o n which would c o n t r i b u t e to the improvement of c o n t i n u i n g education o p p o r t u n i t i e s f o r t h e r a p i s t s in B r i t i s h Columbia. The i m p l i c a t i o n s of t h i s study f o r the planner and some suggested g u i d e l i n e s w i l l be presented i n the next s e c t i o n . One of the major i m p l i c a t i o n s of t h i s study r e l a t e s to the use of s u p e r v i s o r y t h e r a p i s t s as a source of planning i n f o r m a t i o n . Based on the r e s u l t s suggesting s i m i l a r i t y of p e r c e p t i o n about c o n t i n u i n g education h e l d by c l i n i c i a n s and s u p e r v i s o r s , i t can be concluded that s u p e r v i s o r s are f a i r l y 1 30 a c c u r a t e i n p r e d i c t i n g the needs and p r e f e r e n c e s of t h e i r s t a f f . In B r i t i s h Columbia, o c c u p a t i o n a l therapy s u p e r v i s o r s are very a c c e s s i b l e to the planner. The planner may a t t e n d the monthly meeting h e l d by s u p e r v i s o r s or approach them on an i n d i v i d u a l b a s i s with r e l a t i v e ease because of t h e i r small numbers. Both the time and f i n a n c i a l demands of gathering i n f o r m a t i o n f o r p l a n n i n g programs c o u l d be reduced i f s u p e r v i s o r s were a major source of i n f o r m a t i o n . Caution should be used in the case of l a r g e departments in that s u p e r v i s o r s may be more l i m i t e d in t h e i r a b i l i t y to p e r c e i v e t h e i r s t a f f ' s needs because of i n c r e a s e d numbers. Focussing on the s u p e r v i s o r does not exclude the c l i n i c i a n as a source of i n f o r m a t i o n ; the planner should c o n s i d e r both s u p e r v i s o r s and c l i n i c i a n s on the progarm planning committee. Although s u p e r v i s o r s may be able to p r e d i c t the needs and p r e f e r e n c e s of t h e i r c l i n i c i a n s , i t would be p o l i t i c a l y unwise to exclude c l i n i c i a n s from having d i r e c t input i n t o c o n t i n u i n g education programs. The suggested use of s u p e r v i s o r s as a primary source of p l a n n i n g i n f o r m a t i o n rather than c l i n i c i a n s i s based both on the a c c e s s i b i l i t y of s u p e r v i s o r s and on the t r a n s i t o r y employment p a t t e r n s of c l i n i c i a n s . The c u r r e n t a v a i l a b i l i t y of jobs has c r e a t e d a s i t u a t i o n where t h e r a p i s t s change jobs and geographic l o c a t i o n f r e q u e n t l y (Maxwell,1977). Because s u p e r v i s o r s tend to stay i n the same work s e t t i n g f o r a greater p e r i o d of time, they are l i k e l y a b e t t e r gauge of the l e a r n i n g needs and p r e f e r e n c e s of the c l i n i c i a n s in that p a r t i c u l a r work s e t t i n g . In a d d i t i o n , the f l e x i b i l i t y of s u p e r v i s o r s ' working hours in that they are r a r e l y t i e d to p a t i e n t appointments schedules, would be an asset 131 to the planner. I m p l i c a t i o n s f o r programming s p e c i f i c a l l y f o r r u r a l t h e r a p i s t s are c l e a r but suggest r e s t r a i n t r a t h e r than i n n o v a t i o n . Although minimal d i f f e r e n c e s were re p o r t e d between urban and r u r a l t h e r a p i s t s , r u r a l t h e r a p i s t s d i d not r e p o r t s u f f i c i e n t l y d i f f e r e n t needs or p r e f e r e n c e s to p r a c t i c a l l y c o n s i d e r them for s p e c i a l programming. Because so few r u r a l t h e r a p i s t s responded to the q u e s t i o n n a i r e , the planner must r e a l i s t i c a l l y give a low p r i o r i t y to t h i s group c o n s i d e r i n g the l a r g e r group of urban t h e r a p i s t s and l i m i t e d f i n a n c i a l r e s o u r c e s . Had the o v e r a l l need estimate of the r u r a l t h e r a p i s t s been higher than the urban, support would have been provided f o r a d d r e s s i n g t h i s group as a p r i o r i t y . The f a c t that a preference was not shown f o r the type of d e l i v e r y systems that may have met l e a r n i n g needs and reduced b a r r i e r s to p a r t i c i p a t i o n i l l u s t r a t e s the d i f f i c u l t i e s encountered in attempting to address the g e o g r a p h i c a l l y i s o l a t e d t h e r a p i s t . I t i s p o s s i b l e that while the r u r a l t h e r a p i s t s do not p r e f e r d i s t a n c e systems, they would p a r t i c i p a t e i f d i s t a n c e systems were the only o p p o r t u n i t y a v a i l a b l e . It would be necessary f o r the planner to commit the time and f i n a n c i a l resources to a p i l o t p r o j e c t to examine the p r o p o s i t i o n that r u r a l t h e r a p i s t s would att e n d a program using a l e s s p r e f e r r e d d e l i v e r y system in the absence of other a l t e r n a t i v e s . The i n f o r m a t i o n of most immediate relevance to the planner i s d e r i v e d from the needs assessment s e c t i o n of the study. The r e s u l t s suggest that e v a l u a t i o n of c o g n i t i v e f u n c t i o n and perceptual-motor s k i l l s are the areas that are r e l e v a n t to the 132 p r a c t i s e of o c c u p a t i o n a l therapy and in which the need i s g r e a t e s t . The area of v o c a t i o n a l assessment and treatment was a l s o emphasized and should be given p r i o r i t y because of the lack of t r a i n i n g programs a v a i l a b l e in t h i s area. A number of competency areas had both high need estimates and high a v a i l a b i l i t y of t r a i n i n g v a l u e s . T h i s suggests that a number of problems e x i s t in the present p l a n n i n g process. Programs may not be of adequate q u a l i t y , they may not be s u f f i c e n t i n number, or perhaps the b a r r i e r s to p a r t i c i p a t i o n r e p o r t e d by the respondents are g r e a t e r than the l e a r n i n g need. One of the i m p l i c a t i o n s to planners i s that assessment of e x i s t i n g programs i n these areas i s necessary. M a t e r i a l s may r e q u i r e updating, methods of p r e s e n t a t i o n m o d i f i c a t i o n , or t o p i c may need to be ref o c u s s e d to b e t t e r meet the l e a r n i n g needs of the p a r t i c i p a n t s . As many of the e x i s t i n g programs in these areas have l i m i t e d enrollment, r e p e a t i n g them more of t e n may be necessary. The general nature of the competency statements used i n t h i s study has been noted a number of times. Although the u t i l i t y of an assessment t o o l such as the one used in t h i s study i s c l e a r , planners may be able to c o l l e c t more p r a c t i c a l i n f o r m a t i o n by f o c u s i n g the competency statements. Using b e h a v i o r a l l y o r i e n t e d statements or l i m i t i n g assessment to fewer areas with d e t a i l e d d e s c r i p t i o n s , may r e s u l t i n i n f o r m a t i o n of gr e a t e r a s s i s t a n c e in the implementation of programs. The high i n c i d e n c e of s i t u a t i o n a l b a r r i e r s to p a r t i c i p a t i o n r e p o r t e d i n the study can not e f f e c t i v e l y be d e a l t with by the program planner. Aside from a s s i s t i n g the t h e r a p i s t i n the 133 i d e n t i f i c a t i o n of b a r r i e r s , awareness h o p e f u l l y being the f i r s t s t ep i n attempting to reduce b a r r i e r s , s i t u a t i o n a l b a r r i e r s are o f t e n beyond the c o n t r o l of the planner. One i n s t i t u t i o n a l b a r r i e r , l a c k of a p p r o p r i a t e programs, was r e p o r t e d by the m a j o r i t y of respondents and has i m p l i c a t i o n s f o r the planner. One method of i n t e r p r e t i n g t h i s response i s that there i s an i n s u f f i c e n t number of programs o v e r a l l . The e x i s t i n g ones may be r e l e v a n t but too few i n number to allow a l l i n t e r e s t e d t h e r a p i s t s to p a r t i c i p a t e . Encouraging p r o f e s s i o n a l a s s o c i a t i o n s and s p e c i a l i n t e r e s t groups to plan t h e i r own c o n t i n u i n g education programs i s one way to i n c r e a s e numbers. Making a v a i l a b l e experienced planners on a c o n s u l t a t i o n b a s i s would h e l p new program planners produce b e t t e r q u a l i t y programs and a v o i d common planni n g p i t f a l l s . In a d d i t i o n , the d i s t r i b u t i o n of f i n d i n g s of s t u d i e s such as t h i s would encourage c o - o p e r a t i v e e f f o r t s and reduce the chances of d u p l i c a t i o n of programs. Another way of i n t e r p r e t i n g the lack of a p p r o p r i a t e programs i s that the e x i s t i n g programs are not r e l e v a n t to the p a r t i c i p a n t s . One method of i n c r e a s i n g the relevance i s to use a c c u r a t e assessment procedures. Development of new t o o l s which pro v i d e a true r e f l e c t i o n of the needs of the t h e r a p i s t s and are r e l a t i v e l y e f f i c i e n t i n r e l a t i o n to time and cost i s necessary. M i n i m i z i n g the time between the g a t h e r i n g of i n f o r m a t i o n and the implementation of programs would a l s o reduce t h i s b a r r i e r . F r e q u e n t l y , the assessment procedure and a n a l y s i s of the i n f o r m a t i o n i s so time consuming that the i n f o r m a t i o n i s outdated before i t can be acted upon. One of the i m p l i c a t i o n s of t h i s study d e r i v e d from the 134 r e s u l t s of the preference of d e l i v e r y systems i s that the workshop method should be r e t a i n e d as the major v e h i c l e f o r the d e l i v e r y of c o n t i n u i n g education o p p o r t u n i t i e s f o r t h e r a p i s t s . C o n s i d e r i n g f i n a n c i a l c o n s t r a i n t s and the v a r i e t y of areas i n which needs e x i s t , p r i o r i t y should be given to o f f e r i n g r e l e v a n t t o p i c s r a t h e r than the development of new d e l i v e r y systems. S p e c i f i c a l l y , the i n t r o d u c t i o n of e d u c a t i o n a l programming v i a t e l e v i s i o n s a t e l l i t e s should not be c o n s i d e r e d a p r i o r i t y at the present time. The general lack of programs would appear, at l e a s t based on the r e s u l t s of t h i s study and the l i m i t e d resources a v a i l a b l e , to be a more p r e s s i n g problem than the development of new ways of d e l i v e r i n g them. Recommendat ions f o r F u r t h e r Study Upon completion of any r e s e a r c h p r o j e c t a number of a s s o c i a t e d r e s e a r c h problems become apparent. Often these a r i s e from the l i m i t a t i o n s of the r e s e a r c h design of the o r i g i n a l study or from i n f o r m a t i o n r e v e a l e d through conducting that study. The major recommendation in r e l a t i o n to f u r t h e r r e s e a r c h on c o n t i n u i n g education i n o c c u p a t i o n a l therapy i s that a study, s i m i l a r to t h i s one but t a k i n g i n t o c o n d s i d e r a t i o n the l i m i t a t i o n s of t h i s d e s ign, be r e p l i c a t e d to v a l i d a t e both the instrument and r e s u l t s . A l t h o u g h some of the methods used and the f i n d i n g s have support from r e s e a r c h i n r e l a t e d areas of h e a l t h care, a number of the hypothesized r e l a t i o n s h i p s deserve f u r t h e r i n v e s t i g a t i o n . A more r i g o r o u s study would use a l a r g e r sample s i z e and match the sub-samples as c l o s e l y as p o s s i b l e . 135 P a r t i c u l a r l y in the q u e s t i o n s r e l a t e d to s u p e r v i s o r s and c l i n i c i a n s , matched samples and l a r g e r numbers would i n c r e a s e the value of the f i n d i n g s . Although use of the competency statements i n the needs assessment appeared s a t i s f a c t o r y , f u r t h e r study using more b e h a v i o r a l l y d e f i n e d statements i s recommended. T h i s study used only 30 of the 138 competencies i d e n t i f i e d by the Canadian A s s o c i a t i o n of Occupational T h e r a p i s t s , which themselves are not a l l i n c l u s i v e . The r e l a t i o n s h i p s examined d e a l i n g with p r o f e s s i o n a l r o l e and geographic l o c a t i o n should be t e s t e d using other competency areas. Research u t i l i z i n g a broader d e f i n i t i o n of c o n t i n u i n g education may a l s o prove f r u i t f u l . T h e r a p i s t s engaged i n independent types of study were not i n v e s t i g a t e d i n t h i s p r o j e c t , which emphasized formal types of continued l e a r n i n g . Those that update t h e i r s k i l l s and knowledge through j o u r n a l reading, s e l f - s t r u c t u r e d programs such as i n t e r - l i b r a r y loan, or computer a s s i s t e d types of l e a r n i n g c o u l d b e n e f i t from the a s s i s t a n c e of a planner on a c o n s u l t a t i o n b a s i s . S t u d i e s of t h i s group would have i m p l i c a t i o n s p a r t i c u l a r i l y to planning f o r r u r a l t h e r a p i s t s . Another f a c e t of c o n t i n u i n g education not c o n s i d e r e d i n t h i s study was programs f o r c r e d i t . I f c o n t i n u i n g education becomes mandatory as i n a number of other h e a l t h care f i e l d s , i t i s l i k e l y that some type of c r e d i t system w i l l be necessary i n o c c u p a t i o n a l therapy i n the f u t u r e . A s i m i l a r study f o c u s s i n g on the needs and p r e f e r e n c e s of the subsamples in r e l a t i o n t o c r e d i t programs would be v a l u a b l e p l a n n i n g i n f o r m a t i o n . 136 One of the purposes of the study was to attempt to q u a n t i f y l e a r n i n g needs to increase t h e i r u t i l i t y to the planner. I t would be of i n t e r e s t to attempt to a s s i g n some numerical value to the b a r r i e r s to p a r t i c i p a t i o n i d e n t i f i e d by p o t e n t i a l p a r t i c i p a n t s and to develop a formula whereby the r e l a t i v e s t r e n g t h s of the l e a r n i n g needs compared to b a r r i e r s to p a r t i c i p a t i o n were assessed. T h i s would be one i n d i c a t i o n of whether respondents would in f a c t attend programs designed to meet a s p e c i f i c l e a r n i n g need. 137 REFERENCES Aitken, A. Audio methods i n continuing medical education. Medical B i o l o g i c a l I l l u s t r a t e d , 1964, 14, 259-262. American Physical Therapy Association. Competencies i n physical therapy: an analysis of practice. San Diego: Courseware Incorporated, 1977, 419-435. Archambault, R. D. The concept of need. In J . M. Rich (ed.) Readings in the philosophy of education. Belmont, C a l i f o r n i a : Wadsworth Publishing Co., 1966. Atwood, H. 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Washington, D . C : National Association for Public Continuing and Adult Education, 1980, 9-35. Langwell, K., Wilson, S., 6 Paine, R. Geographic d i s t r i b u t i o n of occupational therapists. American Journal of Occupational Therapy, 1981, 3_5 , 299-305 . Lessinger, L. M. E f f e c t i v e caring: an approach to a r a t i o n a l scheme for financing continuing education f o r health manpower. In A. N. Charters and R. T. Blakely (eds.), Fostering the growing need to learn. Syracuse: Syracuse University, 1974, 279-312. Levangie, P. K. Public school physical therapists: role d e f i n i - t i o n and educational needs. Physical Therapy, 1980, 60, 774- 779 . Lorig, K. An overview of needs assessment tools f o r continuing education. Nurse Education I I , 1977 , 2_, 12-16. McBain, P. O.T.'s on wheels. Canadian Journal of Occupational Therapy, 1970 , _37 , 63-68 . McKenzie, N., Postgate, R., £ Schupan, J . Open learning systems £ problems i n post-secondary education. Paris: UNESCO Press, 1975, 15-17. M a d i l l , H. M. Continuing professional education i n occupational therapy. Canadian Journal of Occupational Therapy, 1979, 46, 183-185. Marshall, V. Aging in Canada. Toronto: Fitzhenry £ Whiteside, 1980, 35-42. Matthews, A., £ Schumasters, S, A survey of registered nurses' conceptions of and p a r t i c i p a t i o n factors i n professional continuing education. The Journal of Continuing Education i n Nursing, 1979, 10, 21-28. Maxwell, J . D . , £ Maxwell, M. P. Occupational therapy: the d i f f i d e n t profession. Kingston, Ontario: Queen's University Press, 1977. Monette, M. The concept of educational need: an analysis of selected l i t e r a t u r e . Adult Education, 1977, 2_7, 116-127. 141 Mrtek, M. B., E Mrtek, R. The poten t i a l of programmed review materials i n continuing education. American Journal of Pharma- ce u t i c a l Education, 1971, 3_5> 211-215. Nakamoto, J . , E Verner, C. Continuing education i n health professions. ERIC Clearing House on Adult Education, 1973. Nowlen, P. K. Program o r i g i n s . In A. Know £ Associates (eds.) Developing, administering, and evaluating adult education. San Francisco: Jossey-Bass Publishers, 1980, 13-36. Ontario Nursing Association. Continuing education for nurses: a study for the need for continuing education for R.N.'s i n Ontario^ Toronto: School of Nursing and the Di v i s i o n of University Extension, University of Toronto, 1969. Payton, 0. D. Research: the va l i d a t i o n of c l i n i c a l p r a c t i c e. Philadelphia: F. A. Davis Co., 1979, 57-69, Pearson, K. D i a l access l i b r a r i e s : t h e i r use and u t i l i t y . Journal of Medical Education, 1979 , 4_9, 882-896 . Perry, J . W. Career mobility i n a l l i e d health education. Journal of American Medical Association, 1969, 210, 197-210. Peterson, R. E., and Associates. Community needs of post- secondary al t e r n a t i v e s. Sacramento, C a l i f o r n i a : C a l i f o r n i a Legislature, 1975. Polcyn, K. A. An educator's guide to communication s a t e l l i t e technology. Washington, D.C.: Academy for Educational Development, 1973, 3-8. Popiel, E. Assessing and determining t r a i n i n g needs. In E. Popiel (ed.) Nursing and the process of continuing education. St. Louis:' C. V. Mosby Co., 1977 , 49-59. Pri c e , E. Learning needs of registered nurses. Teachers College, Columbia University, 1967. Punwar, A., £ Werdt, E. C e r t i f i c a t i o n of occupational therapists in the public schools: the Wisconsin experience. American Journal of Occupational Therapy, 1980 , 3_4 , 727-730, Ramey, J . W. Televi s i o n i n medical teaching and research. Washington: U. S. Government Printing O f f i c e , 1967. Rodowskas, C , E'Evanson, R. Continuing education i n pharmacy, motivation and content. American Journal of Pharmaceutical Education, 1969 , 3_3, 735-741. Ruyle, J . , E Geiselman, L. A. Non-traditional opportunities and programs. In K. P. Cross, J , P. Valley and Associates (eds.) Planning non-traditional programs: an analysis of the issues for post-secondary education. San Francisco: Jossey-Bass, 1974. 142 Seymour, R., C o n n e l l y , T., £ Gardner, D. Continuing education: an a t t i t u d i n a l survey of p h y s i c a l t h e r a p i s t s . P h y s i c a l Therapy, 1979 , 5_9 , 399-404. Smallegan, M. C o n t i n u i n g education: how do you b u i l d a program? The J o u r n a l of Continuing E d u c a t i o n i n Nursing, 1981, 12, 12-15. Smorynski, H., £ Panocha, J . P r o v i d i n g c o n t i n u i n g education o p p o r t u n i t i e s i n the a l l i e d h e l a t h p r o f e s s i o n s . J o u r n a l of A l l i e d H e a l t h , 1979 , _8 , 47-54 . S p i c e r , M. R. T r a v e l l i n g t e a c h e r . J o u r n a l of Continuing Educa- t i o n i n N ursing, 1975 , 6_, 17-21. Staub, F. M. 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A d u l t education theory and method: a conceptual scheme f o r the i d e n t i f i c a t i o n and c l a s s i f i c a t i o n of processes f o r a d u l t e d u c a t i o n , Chicago: A d u l t E d u c a t i o n A s s o c i a t i o n , 1962 . Wagner, R. M. The t e a c h i n g of a d u l t s i n the context of d i s t a n c e e d u c a t i o n . In H. R. Baker (ed.) The t e a c h i n g of a d u l t s . Saskatoon, Saskatchewan: U n i v e r s i t y of Saskatchewan, E x t e n s i o n D i v i s i o n , 1977, 1-6. Walsh, P. A model f o r p l a n n i n g c o n t i n u i n g education f o r impact. J o u r n a l of A l l i e d H e a l t h , 1981, 10, 101-106. Weaver, C. H. C o n t i n u i n g e d u c a t i o n f o r emerging p r o f e s s i o n s . J o u r n a l of A l l i e d H e a l t h , 1979 , 8_, 11-15. Wechsler, H., e t a l . C o n t i n u i n g e d u c a t i o n and New England d e n t i s t s : a q u e s t i o n n a i r e survey. J o u r n a l of American De n t a l A s s o c i a t i o n , 1969 , 7_8, 573-576 . White, D. K. C o n t i n u i n g e d u c a t i o n i n management f o r h e a l t h care p e r s o n n e l . Chicago: H o s p i t a l Research and E d u c a t i o n a l T r u s t , 1975 . 143 Woodside, H. B a s i c i s s u e s i n o c c u p a t i o n a l therapy education today. Canadian J o u r n a l of O c c u p a t i o n a l Therapy, 1977, 4_4, 9-16 . 144 REFERENCE NOTES B r i n t n e l l , J . P e r s o n a l communication, October 3, 1981. B r o o k f i e l d , S. D. Di s t a n c e e d u c a t i o n . Manuscript submitted f o r p u b l i c a t i o n , 19 82. Dickson, D. Personal communication, September 24, 1981. Gobert, R. C. M.I.R.C. p r o j e c t . Unpublished M.A. t h e s i s , U n i v e r s i t y of B r i t i s h Columbia, 1977. McGregor, L. Oc c u p a t i o n a l and p h y s i c a l t h e r a p i s t s i n B r i t i s h Columbia. Unpublished M.A. t h e s i s , U n i v e r s i t y of B r i t i s h Columbia, 1975. Qu a s t e l , L. Learning needs and job s a t i s f a c t i o n of community mental h e a l t h workers. Unpublished M.A. t h e s i s , U n i v e r s i t y of B r i t i s h Columbia, 1979. S c o t t , A. Survey of c o n t i n u i n g education heeds of t h e r a p i s t s i n B r i t i s h Columbia" Unpublished manuscript, 1978. ( A v a i l a b l e from School of R e h a b i l i t a t i o n Medicine, U n i v e r s i t y of B r i t i s h Columbia, Vancouver, B.C.). Stan, L. J . The human r e l a t i o n s s u p e r v i s o r y s k i l l s o f rehab- i l i t a t i o n managers. Unpublished M.A. t h e s i s , U n i v e r s i t y o f B r i t i s h Columbia, 1980. APPENDIX A QUESTIONNAIRE 1 4 6 UNIVERSITY OF BRITISH COLUMBIA CONTINUING EDUCATION IN REHABILITATION MEDICINE QUESTIONNAIRE PLEASE RETURN BV DECEMBER 20, 19S1 TO: Lautia Hcuivty, ViAtcXoK Continuing Education in RthabiZiXation UtditUne. The. UnivesuiXy o£ BniXiih Columbia. *J05 - 2194 Utibwok Uall Vancouvvi, B.C. V6T 1US SECTION I 1. In which geographic d i s t r i c t do you work? Vancouver & Lower Mainland Thompson/Okanagan V i c t o r i a Northern I n t e r i o r Vancouver Island (other Central I n t e r i o r than Greater V i c t o r i a ) Fraser V a l l e y 2. How f r e q u e n t l y do you have opportunity to discuss p r o f e s s i o n a l problems and issues with at l e a s t one other occupational t h e r a p i s t ? D a i l y Monthly Weekly Less than 6 t i n e s a n n u a l l y 3. What i s your present job t i t l e ? S t a f f T h e r a p i s t Program C o - o r d i n a t o r / D i r e c t o r Senior T h e r a p i s t I n s t r u c t o r / P r o f e s s o r / L e c t u r e r Sole Charge Consultant A s s i s t a n t Supervisor Other (please s p e c i f y ) Supervisor — A c l i n i c a l t h e r a p i s t 1s a t h e r a p i s t who 1s p r i m a r i l y Involved 1 n d i r e c t p a t i e n t care A su p e r v i s i n g t h e r a p i s t Is one who delegates the r e s p o n s i b i l i t y of 'patient care and spenas the m a j o r i t y of time 1n admin s t r a t i v e o r s u p e r v i s o r y a c t i v i t i e s . In which r o l e do you f u n c t i o n most often? C l i n i c a l T h e r a p i s t Supervisory T h e r a p i s t 5. How many occupational t h e r a p i s t s do you have under your d i r e c t i o n ? (Do not Include students.) 0 1 - 5 6 - 1 0 11 - 15 r ! » ™ than 16 6. How many years experience In occupational therapy have you had? . continued 147 -2- SECTION II If you have checked clinical therapist in item #4, specifying role, complete the remander of the questionnaire as i t pertains to you - a clinical therapist in Occupational Therapy. If you have checked the supervising therapist, complete the remainder of the questionnaire in relation to what you perceive YOUR STAFF'S needs and preferences to be. Do not indicate your personal preferences. 1. There are many reasons why people do not attend continuing education co.urses. Below is a l i s t of common barriers. Choose the three barriers that prevent you/your staff from attending programs and rank them: (1) being the most frequently encountered barrier, (2) the second most frequently encountered barrier, and (3) the third most frequently encountered barrier. (Choose only three.) family responsibilities transportation job responsibilities no appropriate program available cost insufficient advance notice distance inadequate publicity lack of time inconvenient scheduling other (specify) 2. There are a number of ways of making learning opportunities accessible to potential learners. Please rank the three formats you/your staff prefer the most in relation to continuing professional education in occupational therapy. Rank your choices with (1) being the most preferred format, (2) being the second most preferred format, and (3) the third most pre- ferred format. 1 or 2 day workshops audio tapes short courses (1-2 weeks) educational television evening series (3-6 weeks) educational radio travel 1ing consultants correspondence otner (specify) 3. Assuming that educational television were available to you in your home, what type of continuing professional education information would you prefer to be delivered via television? Check only one. basic and applied sciences clinical conditions occupational therapy s k i l l s professional Issues and techniques continued. SECTION III In your staff's present position (or in your position) as a c l i n i c a l therapist, what do you consider to be your staff's (or your) learning needs? There are 136 competencies required of entry level occupational therapists. Below are l i s t e d 30 competencies that the c l i n i c a l therapist frequently encounters. For each of these statements c i r c l e the appropriate number in each of the four categories. (1) indicates a low level of competence or relevance, (2) indicates a moderate lev e l , and (3) indicates a high level of competence or relevance. OCCUPATIONAL THERAPY COMPETENCIES EVALUATION: 1) Identify and evaluate motor function relevance to your role as occupational therapist IOM - high 1 2 3 existing level of competency I M - high 1 2 3 desired level of competency low - hlfh 1 2 3 Is training presently available to you in this area? lo« - high yes no OFFICE use ONLY 2) Identify and evaluate perceptual-motor s k i l l s 1 2 3 1 2 3 1 2 3 yes no 3) Identify and evaluate sensory function 1 2 3 1 2 3 1 2 3 yes no 4) observe and record cognitive function 1 2 3 1 2 3 1 2 3 yes no 5) Identify and evaluate leisure and play s k i l l s 1 2 3 1 2 3 1 2 3 yes no 6) identify and evaluate vocational s k i l l s 1 2 3 1 2 3 1 2 3 yes no 7) identify and evaluate A.D.L. s k i l l s 1 2 3 1 2 3 1 2 3 yes no 8) Identify and evaluate functional communication s k i l l s 1 2 3 1 2 3 1 2 3 yes no 9) Identify and evaluate psychosocial function 1 2 3 1 2 3 1 2 3 yes no THERAPEUTIC PROCEDURES: 10) conduct therapeutic Interviews 1 2 3 1 2 3 1 2 3 yes no 11) select and adopt activities for therapeutic purposes 1 2 3 1 2 3 1 2 3 yes no 12) design and adapt special equipment 1 2 3 1 2 3 1 2 3 yes no OCCUPATIONAL THERAPY COMPETENCIES teievance to | existing level rour role as of competency occupational therapist 1 loo - high j low - high desired level of competency Ion • high is training presently available to you in this area? low - high OFFICE U S B ONLY THERAPEUTIC PROCEDURES continued... 13) employ counselling methods 1 2 3 1 1 2 3 1 2 3 yes no 14) apply sensory-based therapies to develop perceptual motor s k i l l s 1 2 3 1 1 2 3 1 2 3 yes no 15) employ joint mobilization and protection techniques 1 2 3 | 1 2 3 1 2 3 yes no 16) employ muscle strengthening techniques 17) train 1n work simplification and energy conser- vation techniques 18) employ behavior modification approaches 19) employ sodo-drama techniques 20) employ relaxation techniques 21) employ reality orientation 22) employ activation methods 1 2 3 j 1 2 3 1 2 3 1 2 3 1 2 3 j 1 2 3 1 2 3 | 1 2 3 1 2 3 1 1 2 3 1 2 3 1 1 2 3 1 2 3 1 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 1 2 3 yes no yes no yes no yes no yes no yes no yes no 23) u t i l i z e recreation and leisure time act i v i t i e s UTILIZATION OF THERAPEUTIC EQUIPMENT AND MATERIALS: 24) select and u t i l i z e self care equipment and materials 25) select and u t i l i z e rehabilitation aids and materials 1 2 3 [ 1 2 3 1 2 3 j 1 2 3 1 2 3 1 2 3 1 2 3 . 1 2 3 1 2 3 yes no yes no yes no 26) select and u t i l i z e mobility aids 1 2 3 1 2 3 1 2 3 yes no 27) select and u t i l i z e avocational equipment and materials 1 2 3 1 2 3 1 2 3 yes no 28) select and u t i l i z e vocational equipment and materials 1 2 3 1 2 3 1 2 3 yes no 29) select and u t i l i z e projective equipment and materials 1 2 3 1 2 3 1 2 3 yes no 30) select and u t i l i z e developmental equipment and materials 1 2 3 j 1 2 3 1 2 3 yes no APPENDIX B LETTERS OF TRANSMITTAL APPENDIX C LETTER OF SUPPORT

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