2 Introduction to Role-Emerging Placements

What is a Role-Emerging Placement?

Fieldwork placements traditionally have an Occupational Therapist (OT) on site who supervises the student to help them learn the skills required as an OTA&PTA. In a role-emerging placement, the fieldwork placement site does not have an established OT role or OT program, and does not have an onsite OT fieldwork supervisor (Bossers et al., 1997a, Shimmell and Dix, 2014). While role-emerging placements do not have an onsite occupational therapist, they do have clients that would benefit from occupational therapy services (Bossers et al., 1997b).

The students in role-emerging placements have a non-OT “onsite supervisor” who oversees their daily activities. The college provides an “offsite” clinical instructor who is a registered Occupational Therapist, to provide the student and program an OT lens and to assign tasks for the student to complete on placement. The OT clinical instructor will provide some direct onsite supervision with the student and onsite supervisor. This is a collaborative model of supervision, where the OT Clinical Instructor also provides indirect supervision and consultation to the onsite team and student(s). The OT Clinical Instructor is actively involved in providing feedback and evaluation of student performance in collaboration with the onsite supervisor.

Benefits of Role-Emerging OTA Placements

For students:

• Opportunities for develop the following skills: building client-centered and therapeutic relationships, team consultation and collaboration, advocacy, critical thinking and time management (Syed and Duncan, 2019)
• Opportunities for students to develop skills required to work in emerging areas of practice (Dancza et al., 2013)

For the profession:

• Advocating for potential occupational therapy services in non-occupational therapy environments and for use of occupational therapist assistants.

For the placement facility:

• Clients are able to access occupational therapy services at no added cost to the program.
• The facility builds capacity amongst staff through the knowledge translation between the OT/OTA and staff onsite.

Challenges of Role-Emerging OTA Placements

For students:

• It can be challenging communicating the OT role and understanding the range of the student’s activities as an OTA. (Sharmin, 2015)
• Lack of direct onsite supervision by an OT, OTA, or presence of other OTA&PTA students to discuss ideas when only one student is placed in a setting. (Sharmin, 2015)
• There is the potential for the student to become another staff member and lose focus on the occupational therapy role (Cooper & Raine, 2009)

For the profession:

• Time limited nature of placement makes it challenging to maximize potential role. (Sharmin, 2015)
• Arranging for registered occupational therapists who can provide offsite preceptorship to students who are experienced and comfortable with this role (Jung, Solomon & Cole, 2005)

Partnering for Change Model

Partnering for Change is a service delivery model in which a needs-based, tiered approach is used to provide rehabilitation services (McMaster University, 2020). This approach has been adapted to provide occupational therapy services using an occupational therapy assistant in role-emerging placements. The idea is to build capacity through collaboration and coaching in context (McMaster University, 2020). The OT/OTA build relationships and transfer knowledge to onsite staff with the intent to apply the principles of universal design for learning and promote the health of all clients within the facility.

The overall goals of the OT/OTA are to:

1. Facilitate early identification of clients requiring intensive services.
2. Build capacity of onsite staff to understand and manage client’s needs.
3. Enhance client’s participation in onsite programming.

This approach to service delivery relies on the onsite staff, caregivers and the OT/OTA to create physical, social and learning environments that will facilitate all clients’ participation in programming. The Occupational Therapist provides consultation services to the facility, and therefore, does not do individual formal assessments and treatment. The OT may do screenings to determine suitability for programming. By implementing universal design for learning principles, the OT/OTA is able to create an environment that fosters the development and participation of clients of all abilities.

This approach allows for screening and differentiated instruction for clients who are experiencing challenges. The OT/OTA will monitor the responses of client’s to individualized strategies and accommodations which will allow them to participate in a different way. As the whole facility is the target of intervention, this allows the therapist and OTA to impact more clients than a traditional service delivery model. The collaboration and intervention occurs within the context of the program environment (McMaster University, 2020).