Barriers/Perceived Constraints and How to Overcome Them

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In the following section, we highlight some of the common barriers reported re student placements in the Private Practice sector and highlight some useful strategies for overcoming these potential barriers.

 

BARRIERS

Rorke (2005) conducted a literature review and a survey of private practitioners. Our understanding of his findings of identified barriers to student placements in the Private Practice sector are listed below:

  • Cost
  • Time
  • Legal/Ethical Issues
  • Fluctuation in Case Load
  • Too Little Client Contact Time
  • Student Characteristics e.g. flexibility, prior exposure, willingness to learn
  • Travel
  • Clients may experience a decreased satisfaction with service if treated by a student
  • Insurance Companies would not be willing to pay for student delivered therapy services
  • Students may decrease productivity in private practice (and time is money)
  • Space
  • Emotional cost

The Queensland Occupational Therapy Fieldwork collaborative added to that list the following items:

  • Uncertainty about the criteria for effective student clinical education in a private practice setting
  • Use of intellectual property and implications of the improper use of intellectual property by the student
  • Poor relationship with the universities, curriculum and recognition of their contribution.

 

SUGGESTIONS TO OVERCOMING BARRIERS

The Queensland Occupational Fieldwork Collaborative have utilised Rorke’s 2005 paper and outlined some suggestions to overcoming these barriers.

The following is a summary of the suggestions to overcome barriers from this document.

 

Third Party Payers and fee-for-service paying clients

  • Provide clear student identification
  • Develop a written consent form for client/third party consent
  • Ensure the level of student involvement is clearly explained to client
  • Use verbal consent
  • Gain client confidence

Risk and Legal Issues:

  • Become familiar with conditions of insurance cover by universities for :
            1. Student public liability cover
            2. Professional Indemnity
            3. Workers Compensation/Personal Accident Insurance
  • Provide orientation to workplace health and safety issues in the practice environment
  • Ensure competence of the student before the student conducts the service/assessment
  • Always carefully check student’s documentation or written reports prior to signing
  • Check student understanding of any directions given regarding performance of an intervention or procedure prior to performance

 Intellectual Property

  • Provide students with explicit guidelines about access to information and copying of resources specific to and developed for your private practice
  • Consider developing a site-specific written and signed confidentiality agreement between you, the practitioner and the student regarding the proper use of confidential information and intellectual property
  • Identify university policies on intellectual property and how to protect your IP rights. The Occupational Therapy Practice Education Collaborative - Queensland have provided some information around confidentiality and intellectual property for students at this link.

Medico-legal assessment

  • Due to potential significant risks to the practitioner and public, a registered practitioner should always be present during any student involvement in any part of a Medico-legal assessment
  • At the discretion of the clinical educator, students may be given responsibility for small aspects of the assessment under the direct supervision of the practitioner e.g. assessing range of motion

Home Visiting

Due to the differing contexts, settings, clientele and associated risks with home visiting, universities rely on the organisation or practice that is providing the student clinical placement to develop or reference a home visit policy specific to their setting. It is recommended that you develop or review a:

  • Home-visit policy which can include:
                1. mobile phone use and communication
                2. Student’s previous contact with the client
                3. Clinician’s knowledge of the client
                4. Experience required by the student
  • Home visit risk checklist specific to the practice setting and clientele

Fees for service

As yet, there are no defined guidelines regarding the issue of payment for student services. It is important that you provide clear communication to the client or paying party about the nature of fees at your practice.

 

Student Characteristics/Selection Issues

To assist the universities, you can provide them with a placement profile, containing explicit requirements and details about your practice placement. It is very important you develop a relationship with the University Placement Coordinators to assist with this.

 

Caseload fluctuations e.g. limited “hands on” client contact time

Although the consistency and variety of hands-on student clinical experiences may at times have limitations in this field, private practice as a clinical education environment provides many valuable learning opportunities for a student’s professional growth and development. These include:

  • access to a diverse range of contexts and delivery systems in which to apply a variety of skills
  • development of skills in administration, marketing, networking and promotion of a service
  • increased awareness of working within budgetary and legislative constraints
  • development of professional reasoning and professional relationships for successful creation and running of a business
  • enhanced knowledge of community resources
  • development of formal report writing skills
  • involvement in administrative projects such as marketing strategies, continuing education, updating of resources
  • observation of and liaison with other professionals in private practice and within the health care delivery system such as rehabilitation case managers
  • development of an identity as an occupational therapist and an understanding of the occupational therapy process

 

REFLECTION ACTIVITY

For each area listed above complete the following questions:

Is this a potential barrier in my setting?

If yes, if this is something you have not addressed already, can I apply the suggestions to my setting to overcome this barrier?


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