Content area
Purpose
This paper aims to expand the arguments put forth by (Van and Kubina, 2024) and discuss Precision Teaching (PT)’s role within allied health professions (AHPs).
Design/methodology/approach
With services by AHPs becoming increasingly difficult to access, the need to accurately measure the efficacy of any input, however, limited, is a matter of priority, both for the sake of the service user and to ensure ongoing public funding of these professions. This commentary provides current clinical examples of the challenges faced by these professions.
Findings
The author discusses the use of PT as a way of ensuring the skills of AHPs are used as efficiently as possible.
Originality/value
Practical implications are discussed.
The paper (Van and Kubina, 2024; this issue) provides useful examples of the use of Precision Teaching (PT) in allied health professional practice. There is considerable scope to develop this further for various reasons and in various ways. Caregivers of children and adults with additional needs are invariably keen on the input of occupational therapists (OTs), physiotherapists (Physios) and speech and language therapists (SaLTs). However, much of their input is delivered in a way that is neither quantifiable nor enables caregivers and professionals to measure and compare progress to the performance of the skill(s) in question at baseline. Arguably, the involvement of the health professional, however fleeting or sporadic, becomes the point of focus, rather than any meaningful changes resulting from an occurrence of their involvement. Whilst the placebo effect of the presence of a professional is well known (Miller et al., 2009), those of us who are allied health professions (AHPs) would undoubtedly prefer any favourable outcomes in our service users to be the result of our clinical skills rather than merely our physical (or illusion of physical) presence.
Public sector health professional provision is becoming scarcer. For example, in speech and language therapy, there are currently vacancy rates of 25% in children’s services and 24% in adult services (Royal College of Speech and Language Therapists, 2023). Clinicians are increasingly required to consider evidence-based practice and the use of measurement in their work. OTs, Physios and SaLTs are all AHPs regulated by the Health and Care Professions Council, which stipulates proficiency standards. For example, SaLTs are required to recognise the value of gathering and using data for quality assurance and improvement programmes (Health and Care Professions Council, 2024).
Within this context, the enormous challenges public sector AHPs face to manage a large caseload demonstrate the efficacy of their input and meet the demands of their service users cannot be underestimated. This is why increasing numbers of professionals (including myself) are choosing to leave the National Health System. A recent review of OTs revealed that 63% felt they were too busy to provide the level of care they would like, and a quarter of respondents said they intended to stop working as an OT practitioner within the next five years. This is despite 93% stating that occupational therapy is a rewarding career (Royal College of Occupational Therapists, 2023).
The effects of lockdowns due to COVID-19 have also had a devastating effect on children’s global development, particularly those who were already classed as disadvantaged before lockdown (Education Endowment Foundation, 2022). PT provides a time and energy-efficient method of measuring progress. It also enables the typical demands and expectations of AHPs to be broken down into meaningful chunks via element-compound analysis. In my collaborative clinical practice, my colleagues and I are frequently asked to teach individuals to dress, tell the time, “eat nicely,” “speak clearly” or “walk properly.”
AHPs are poorly trained in task analysis and measuring performance in each step of a larger goal, before bringing the discrete elements together. For example, in my own collaborative clinical practice, my colleagues and I will be frequently asked to teach individuals to dress, tell the time, “eat nicely”, “speak clearly” or “walk properly”. I typically come across teaching staff who are attempting to teach a child to understand and use concepts like “quarter to” or “half past” on a clock face when it is clear that the individual has no understanding of the terms “long hand” and “short hand” and quite often, not even that of “hand” in the context of a clock. Another common practice is to set a goal of “greeting others appropriately” for an individual who is not able to remember or say the names of those whom they are expected to greet.
In both the above examples, the use of the element-compound analysis (a.k.a component-composite) in combination with PT provides an effective way of setting and measuring clear goals in a way that means the practice of the individual elements can be carried out without the physical presence of an AHP. Explicit instruction to caregivers on taking data also means that there is something concrete to discuss at the next contact with the AHP. This also motivates the caregiver to record data, as they will be fully aware that the AHP will expect the production of this data at the next meeting. The familiar aphorism in the field of behaviour analysis of […] if it’s important enough to teach, it’s important enough to measure is, I find, an efficient way of persuading caregivers to take data.
It is a common view that PT and using the standard celeration chart are complex skills to teach caregivers. This position has always been personally problematic because PT practitioners understand element-compound analysis better than most. In my clinical experience, I have found the concept and delivery of time-bound measurement easy to convey to caregivers. It is helpful to start with practising simple fine or gross motor movements to begin with, even if that is not the ultimate therapeutic goal. Teaching someone to measure, for example, the number of steps up and down on a low bench that a child can execute in a minute is a straightforward task. The data recording and subsequent performance improvements encourage them to continue and develop the skill. However, I recognise that as an experienced clinician working primarily in long-term and stable collaborations with caregivers, I am at an advantage. It is perhaps not quite so easy for a younger AHP or one who is only able to provide very short-term episodes of care. Equally, the success of such an approach is predicated on the AHP being a skilled precision teacher themselves for skills and knowledge transfer to occur. A solution may be for skilled precision teachers who are not AHPs to be deployed in clinic, school and home settings to assist AHPs in element-compound analysis so that PT programmes can be established and monitored. Indeed, one of the most rewarding aspects of my work is collaborating with colleagues who are SaLTs, Physios and OTs, discussing what they want to be done and why, and helping them to set up PT programmes.
However, it is a matter of concern that fewer and fewer behaviour analysts are aware of, let alone practice, PT despite Skinner considering his most important contribution to the science of behaviour to be the frequency of responding in free operant conditions (Binder, 1996; Potts et al., 1993). Therefore, identifying precision teachers becomes a challenge.
The current situation regarding the diminishing provision of meaningful, measurable public sector AHP provision is nearing collapse. This, combined with increasing pressure to provide value for money, may lead commissioners to seek out radically different service delivery methods. There is considerable scope for the PT community to offer their services to address the situation. The biggest challenge will be how to “sell” this as a solution and not merely add to the ever-increasing tiers of intervention, which in most cases add little to the quantitative and qualitative outcomes of the service user in question.
© Emerald Publishing Limited.