Quality Practice

In accordance with the Health Professions Act, the College is responsible for delivering a Quality Assurance Program (QAP) that supports and monitors continued competence.

All registered occupational therapists in B.C. must participate in and satisfy the annual requirements of the program.

Annual Continuing Competence Review

The purpose of the Annual Continuing Competence Review (ACCR) is to support and enhance occupational therapists’ continued competence.

Highlights from COTBC’s 2022 ACCR

When completing the ACCR occupational therapists:

• review their practice hours, roles, and reflect on current and pending personal and career transitions, and resources to support these transitions; and
• complete a practice quiz using practice cases. This quiz helps occupational therapists to identify gaps in understanding regarding newly released standards, and recent changes in legislation (e.g. naloxone administration). In 2018 we introduced cases/questions focused on specific clinical areas where new evidence, best practices or new processses should trigger changes in practice.

After completing the required activities, occupational therapists immediately receive an individualized feedback report. It includes a record of their:

• practice (currency hours)
• perceived confidence in various roles;
• identified transitions and resources impacting practice; and
• practice quiz results with detailed College explanations including links to relevant resources on regulatory standards and practice resources to encourage further exploration and learning.

Individual results from the Annual Continuing Competence Review are not available to the College. The College will only know which occupational therapists completed it and can therefore renew their registration. The confidentiality of these results is ensured by directing OTs to a secure, password-protected website that is not accessible to the College. COTBC can request anonymized aggregate data to inform development of additional College resources and continuing professional development needs of occupational therapists but they do not have access to individual records.

2022 Annual Continuing Competence Review Results

The College’s Quality Assurance Program (QAP) supports registrants to maintain and enhance their continuing competence. The ACCR is one component and is often referred to as the heart of the program. It is designed to support occupational therapists by providing learning opportunities (including assessment and feedback) and resources focused on their required professional standards. Completed by registrants in an online format every year as a requirement for renewal of registration, the ACCR includes several features to support reflection and learning. Features such as reviewing practice hours and roles, applying their knowledge through case scenarios, and identifying professional development goals combine to support registrants to develop plans to enhance their continuing competence. The College is also able to use the aggregate data to develop resources to promote high standards of practice.

The 5 Most Frequently Identified Transitions Influencing Competence

Transitions are a natural part of work, experienced as a process of change that occurs when moving from usual routines to new ones. Within the ACCR, occupational therapists are asked to recognize, prepare for, and take action to manage transitions to maintain their competence and reduce risks to their clients’ safety. This year, there was a change to the top three transitions for the first time since 2013, with transitions involving managing staff shortages and providing caregiving (for children and aging parents) identified more frequently than previous years.

1. Significant change in my workload (20%)
2. Adjusting to a significant change in my family demands that impacts my practice (16%)
3. Recent change in policies and/or procedures at my workplace that impact the way I practise (13%)
4. Adjusting to a significant change in my workplace organization (e.g., a change in reporting structures or less contact with peers and increased isolation) (12%)
5. Adjusting to a significant change in my practice setting (e.g., moving from acute care to home health care, or into private practice) (11%)

Practice Quiz Results

As part of the ACCR, registrants are required to complete a Practice Quiz comprised of case-based scenarios and questions. Case scenarios are based on newly released standards, recent changes in legislation, or specific clinical areas where new evidence, best practises or new processes should prompt changes in practice. In 2022, registrants most frequently scored between 80-90% on the Practice Quiz. Additionally, 90% of survey respondents agreed that in general, the content in the Practice Quiz was appropriate to assess safe, ethical, and competent occupational therapy practice and 91% of respondents agreed that overall, the experience felt supportive and educational.

Continuing Professional Development

Registrants are required to identify a continuing professional development (CPD) goal as part of completing the ACCR. 92% of respondents indicated they would use their CPD goal to guide their continuing competence for the upcoming year.

The 12 Most Identified Areas of Focus for CPD (in order of frequency)

1. Mental Health Assessment and Interventions (e.g., CBT, DBT, exposure therapy for PTSD, motivational interviewing, suicide risk, grief, trauma informed care, anxiety, mindfulness, acceptance and commitment therapy, progressive goal attainment program, psychological first aid, sensory and emotional regulation, substance use and harm reduction)
2. Adult and Older Adult Assessment and Interventions (e.g., stroke, complex pain, hand therapy, aging in place, arthritis, constraint-induced movement therapy, driver rehabilitation, dysphagia, dementia, caregiver support, living at risk, low vision, maternal health, hoarding, falls, delirium, end of life care, c-spine collars, splinting, skin and wound care)
3. Occupational Therapy Quality Practice Processes (e.g., efficacy of documentation skills, education and teaching skills, personal health and wellness strategies, research skills, building professional support networks, self-reflection skills, strengthening interprofessional teams, applying ethical frameworks, caseload prioritization skills, mentoring OT and RA students, working with support personnel, applying risk assessment and management approaches, reviewing regulatory and legislative resources, attending professional conferences)
4. Pediatric Assessment and Interventions (e.g., autism, dysphagia, feeding and eating skills, sensory and emotional regulation, assistive technology, handwriting development, DCD, anxiety, school-based practice, attachment theory, building relationships with parents/guardians, JASPER model, parent/teacher coaching, CO-OP approach, NICU services)
5. Cognitive Assessment and Interventions (e.g., brain injury, concussion, delirium, determining capacity for decision-making, executive function, functional vs. standardized assessment tools)
6. Leadership (e.g., business practices, conflict resolution, change management, mentorship, coaching, providing feedback, having difficult conversations, knowledge translation strategies, evaluation and outcome measurement tools, program development, communication skills, leadership styles, advocacy, public speaking, interprofessional practice)
7. Seating, Positioning and Technology Assessment and Interventions (e.g., complex wheelchair prescription, support surfaces, ADL equipment provision practices, home modifications, environmental controls, universal design, community accessibility, writing letters of justification, knowledge of innovative equipment and assistive technology)
8. Indigenous Cultural Safety and Humility (e.g., self-reflection, understanding of history, impact of intergenerational trauma, practical suggestions for real practice change, heartfelt opportunities for relationship, learning and partnership building)
9. Justice, Equity, Diversity, and Inclusion (e.g., practical considerations for addressing and taking action regarding discrimination, racism, inequality, ableism, biases, and systemic barriers in practice)
10. Private Practice Assessment and Interventions (e.g., business management, hand therapy, workplace injury prevention, developing return to work plans, Functional Capacity Evaluations, Cost of Future Care assessments, testifying in court, ergonomics)
11. Regulatory and Legislative Resources Applicable to Practice Area (e.g., obtaining consent for OT services, disclosure of information, application of legislation and COTBC practice standards)
12. Complex Pain Assessments and Interventions (e.g., pain management skills, education provision, cognitive-behavioural interventions, sleep hygiene, ergonomics, workplace/home modifications, assistive technology, activity analysis, injury prevention).

Other notable themes included assessments and interventions related to post-COVID conditions and substance use practice areas, as well as best practices for providing virtual health services.

Note: intervention means action taken to improve functioning or prevent harm.

ACCR Plus Pilot Project

In the Spring of 2023, the College was preparing to launch the ACCR Plus pilot project when the BC Ministry of Health confirmed their intent to amalgamate 11 health profession regulatory colleges by June 2024. Given the new timeline, focus was shifted to other operational initiatives.

The ACCR Plus pilot project was developed to test a new quality assurance screening and assessment process. The intent was to place a greater emphasis on competency-based tools through a risk-based approach, encouraging registrants to focus on practice supports and root causes that impact their ability to provide safe and competent services. The College looks forward to working with our future colleagues as amalgamation work plans related to quality assurance programs are developed.