rehabinkmag Commentary, Issue 14

“It’s about Living”: Insights from a Role-Emerging Placement in Occupational Therapy

Commentary

By Kathryn Lambert, Molly Beauregard, & Nathalie Klinger

A central component of occupational therapy (OT) education is the opportunity for students to apply their knowledge and skills on clinical placements. Students typically participate in several placements, each under the full-time supervision of an occupational therapist. Approximately 5%  of placements in Canada are classified as role-emerging placements (REPs) (1). In REPs, the placement setting is an organization that does not have an occupational therapist on staff. Two students work together to independently carve out a role for occupational therapy for the organization’s clientele over the course of the placement. While this role varies according to the nature of the organization, common components include the development of group treatment programs, the creation of educational resources, and the administration of equipment assessments, such as assessing a client with mobility needs for a walker. A professional employee of the  organization supervises the students on-site, while a registered occupational therapist outside of  the organization provides around eight hours of mentorship per a week.

REPs provide a range of potential benefits to students, the target organization, and the profession of OT as a whole. Through REPs, students and professors are able to initiate placement opportunities that facilitate student development of unique and timely skills. By definition, these placements fill healthcare gaps by providing OT services to clients who would otherwise have limited or no access to the profession (1,2). The increased use of REPs has led to an increase in both student willingness to work in non-traditional settings such as not-for-profit organizations and has also added to a number of new job opportunities in such settings (2). Successful REPs through the University of Alberta have resulted in the establishment of permanent OT services at both the Bissell Centre, a not-for-profit organization that supports low-income and homeless Edmontonians, and Henwood Treatment Centre, a residential addictions treatment centre in Edmonton (1).

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SHVETS Production (Pexels)

An REP at the Parkinson Association of Alberta

In January of 2022, two students (MB & NK supervised by KL, a practicing occupational therapist) participated in the first iteration of a REP at the Parkinson Association of Alberta, a not-for-profit organization that supports Albertans with Parkinson’s Disease and their loved ones. The placement was developed by KL in collaboration with Brandi, the operations manager at the organization, following a discussion on the lack of knowledge regarding OT in the Parkinson’s Disease community. As explained by Brandi: “I think OT is a newer concept for them [our clientele], even though it has been around for forever. A lot of them just attach OT to home care. And it’s a wonderful function of home care! However, there’s so much more OT can help with before you even get to that point.

Over seven weeks, the students offered a combination of individual treatment, group treatment, and educational programs to organization clientele. Programs took place both in person and online, with no restrictions placed on program eligibility. While the group treatment and educational programs were delivered by the student pair as a team, each student was assigned a caseload of several clients with whom they worked individually over the course of the placement, which ensured that both students were exposed to a diverse clientele

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Matthias Zomer (Pexels)

The Unique Benefits and Challenges of an REP

The assignment of individual caseloads, and the accompanying responsibilities, was a particular  highlight for the students. Both felt a significant sense of ownership over the development and  administration of each client’s treatment plans. This ownership, which has been noted by previous REP students (2), led to strong feelings of pride regarding what had been accomplished during the placement. While the students worked with less clients on average than those in  traditional settings, their involvement with each client was greater than that of their peers. Experiences of students participating in REPs more closely resembled the role of practicing occupational therapists.

The willingness of students to work on activities that might seem inconsequential or unimportant to other individuals was appreciated significantly by clients. The students worked on a range of goals, from putting on a jacket, to keeping up with computer work while on the job, as well as preventing fatigue during jewelry making. The importance of these small tasks to clientele is illustrated by the following quote from Brandi: “But I think it’s those little things first because those little things are your independence and your functionality that I think are actually eating away at the confidence long before we see it [at the Parkinson Association of Alberta]. It’s happening in your bathroom as you’re trying to brush your own darn teeth, it’s happening in a restaurant because you can’t button up your pants on your own anymore. So, what happens before we get to hear about it, they stop doing these things.”

Brandi mentioned that for many clients unfamiliar with OT, getting to work with students was what initially what drew many clients to participate in the program. “The clients were saying, well there’s students here, right? Like, let’s show them Parkinson’s. And so, yes, they came in with goals and the students got to work on things. But I think if they weren’t students, the clients might not have done it. It was more like, okay, like let’s show them the disease and then oh, I actually get to work on things as well. And that’s this really nice combination [for the clients].” By working with students, the clients were exposed to the benefits of OT while also feeling that they were contributing to the student’s knowledge about their disease.

More than half of the program’s clientele lived outside Alberta’s major cities (Calgary and Edmonton). The clients in these communities reported either limited or no access to comprehensive OT services prior to working with the students. Brandi identified the willingness of students to provide virtual programming as a key component of the program’s success. “I really look forward to the day where we figure out how to solve the rural conundrum. But what’s unique about our engagement with your team is that you were willing to look beyond the traditional, because the world is bigger and the access to help is smaller.”

The challenges experienced during the placement echo those reported previously in the literature.  Much like other REPs, the placement at the Parkinson Association of Alberta was slower in pace,  particularly at the beginning as the students explored the organization and its programming (2).  Additionally, exposure to an experienced occupational therapist was more limited than in a traditional fieldwork setting, where students receive full-time support as opposed to weekly supervision. While this decreased supervision can foster independence, it also led to concerns about missing out on valued mentorship (2). Other challenges to the placement stemmed primarily from its occurrence during the COVID-19 pandemic, which resulted transferring programming online.

“It’s not just about surviving anymore for our clients, it’s about living”

Closing Thoughts

It is an unfortunate reality that Canadians do not have equitable access to occupational therapy  services, and this includes individuals living with Parkinson’s Disease. REPs provide an imperfect solution to this challenge. They are temporary in nature, and the limited supervision is not beneficial for all students. Like any placement, the student experience also varies on factors such as setting and client dynamics. The REP at the Parkinson Association of Alberta exposed a range of clients to the practice of occupational therapy while also providing students with a valuable learning opportunity. As Brandi stated when explaining what occupational therapy could bring to their organization, “It’s not just about surviving anymore for our clients, it’s about living.”

Acknowledgements

Featured illustration by Vadym Lytvynov for rehabINK.

To refer to this article, it can be cited as:

Lambert K, Beauregard M, Klinger N. “It’s about living”: Insights from a role-emerging placement in occupational therapy. rehabINK. 2023:Issue#14. Available from: https://rehabinkmag.ca

References

  1. Schmitz C, Storr C, White, C. How Role-Emerging Placements Compare to Each Other & Contribute to Occupational Therapy Practice: A National Snapshot. Occupational Therapy Now (Canadian Association of Occupational Therapists). 2018 Jan; 20(1), 14-16.
  2. Dancza K, Warren A, Copley J, Rodger S, Moran M, McKay E, Taylor A. Learning experiences on role-emerging placements: an exploration from the students’ perspective. Australian Occupational Therapy Journal. 2013 Dec;60(6):427-35.