Support workers, therapy assistants, and your child's therapy program

DisabilityNDIS
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Using allied health assistants, therapy assistants, or support workers to help supplement a child’s allied health therapy is a great opportunity coming out of the introduction of the NDIS.  In this blog post, I hope to share some information to help parents to decide whether, why and how to engage a therapy assistant in order to optimise the outcomes for their child and family.

So, what is the difference between a therapist and a support worker?

Therapists:

Allied health professionals (ie: physiotherapists, occupational therapists, speech pathologists, dieticians, psychologists, social workers) are university trained professionals that have specific high level skills in their discipline area.  Allied health professionals are responsible for assessing, identifying, diagnosing, making recommendations, treating and supporting people with health conditions, developmental disorders or disabilities.  Allied health therapists must be registered to practice, either through the Australian Health Practitioners Regulation Agency (AHPRA), or another professional regulatory agency (like Speech Pathology Australia).  In order to remain registered and to be allowed to practice in their profession, allied health professionals must only do what they have the skills and knowledge to do (work within their scope of practice), are required to spend a certain number of hours each year keeping up to date with research and furthering their clinical knowledge and skills, and must hold professional indemnity and public liability insurance while practicing.

Support workers (and therapy assistants):

The term support worker covers a wide range of workers with different roles and responsibilities, but all of which include supporting a person with their daily care and/or activity programs.  There is currently no national consensus on the specific roles, responsibilities or titles of support workers and these may vary according to the environment in which they work, but generally include providing care and support to people with disabilities.  Some support workers may have TAFE Cert III or IV qualifications, and some support workers may have no qualifications.  Support workers have no professional registration requirement, no mandatory requirement for ongoing professional development, and no mandatory requirement to hold indemnity or public liability insurance (although many will).

When to use a therapist and when to use a support worker or therapy assistant?

Only a qualified allied health professional can conduct an assessment of your child's development and their needs, identify and potentially diagnose your child's movement difficulties, provide specific education about your child's condition, make treatment recommendations, design and develop treatment programs, and deliver specialised treatment or therapeutic interventions.  However, the Australian Physiotherapy Association (APA), Occupational Therapy Australia (OTA) and Speech Pathology Australia (SPA) all support the involvement or use of support workers and/or therapy assistants to complement the role and services delivered by allied health professionals, by undertaking some of the duties that require less developed skills.

As a result of the difference in knowledge and skills, there will be some children, situations and/or therapy activities that are better carried out by an allied health professional rather than a therapy assistant.  These include:

  • Children who:

    • have medically unstable conditions and require close monitoring

    • have complex movement difficulties or complex disabilities

    • have significant deformities that require careful handling and facilitation

    • have significant behavioural difficulties

  • Situations like:

    • early in a child’s rehabilitation when they are improving or changing rapidly

    • following a specific intervention such as Botox or surgery

    • when a child needs to trial a specialised piece of equipment

  • Therapy activities that:

    • require specialised handling and facilitation of movement

    • involve the maintenance of optimal posture and positioning

    • require constant or frequent modification and adaptation in response to your child’s efforts and abilities

    • on the spot clinical reasoning and problem solving

    • are new to the child

    • are physically or mentally challenging or taxing, and the therapist wants to push your child’s abilities

    • involve the use of specialised equipment that is not yet part of the child’s home therapy routine

This list is not exhaustive, but it can give parents an idea about whether or not the introduction of a support worker or therapy assistant might be suitable for their child at a specific point in time.

What is the difference between a support worker and a therapy or allied health assistant?

The national register for training in Australia (training.gov.au, in: HLT42512 - Certificate IV in Allied Health Assistance) defines allied health assistants as:‘

Workers who provide therapeutic and program related support to allied health professionals. The worker is required to conduct therapeutic and program related activities under the guidance of an allied health professional. Supervision may be direct, indirect or remote and must occur within organisation requirements. The worker is required to identify client circumstances that need additional input from the allied health professional.’

The Australian Physiotherapy Association (APA), Occupational Therapy Australia (OTA), and Speech Pathology Australia (SPA) all recognise Allied Health Assistants (AHA’s) or therapy assistants as being those support workers that:

  1. hold a Certificate IV in Allied Health Assistance, and/or

  2. who are directly employed and supervised by a registered allied health professional

As a result of this employment arrangement, it would be expected that therapy assistants receive ongoing training, supervision and support from the allied health professional to ensure that the work they perform is to a certain standard.   This means that the types of tasks and activities that a therapy assistant can do may include some activities that require a higher level of knowledge and skill than what another support worker might be able to do.  In addition, therapy assistants are usually covered under the allied health professional’s or allied health business’s professional indemnity and public liability insurance.

Why might it be useful to have a support worker or allied health/therapy assistant helping with my child’s therapy program?

The benefits of having a support worker or therapy assistant helping with your child’s therapy program can include:

  • Support workers and therapy assistants are cheaper – by having a support worker or therapy assistant complete a home program with your child, your child may be able to do more therapeutic activities with their funding.

  • Support workers or therapy assistants can take the load off you as a parent – parents of children with disabilities already have a lot on their plate; by engaging a support worker or therapy assistant to do your child’s home program with them, you might be able to free up some of your own time for work, household tasks, spending time with your other children, etc.

  • Your child may respond better to and work harder with a support worker or therapy assistant than a parent – some children (most children???) may behave better and try harder when they are doing exercises for a support worker or therapy assistant, than if they were doing the same activities or exercises with their parents.

What activities can a support worker or allied health/therapy assistant do?

The types of activities a support worker or therapy assistant can undertake will vary.  Whether a support worker or therapy assistant can help to implement a child’s therapy program will depend upon:

  1. the child’s and family’s needs

  2. the nature of the therapy activities and the knowledge and skill level required

  3. the support worker/allied health assistants’ level of competence, training and experience, in general and in the specific therapy activities

  4. the relationship that exists between the support worker/allied health assistant and the allied health professional, and

  5. the level of training and supervision able to be provided to the support worker/allied health assistant by the allied health professional

Ultimately, the allied health professional holds legal responsibility for the safe and effective delivery of the therapy program to the child (ie: the physiotherapist is responsible for the delivery of all physiotherapy services for a child) – subsequently, it is up to the allied health professional to determine if a support worker/therapy assistant can safely and effectively carry out each activity within the program for each child.

How can we ensure the therapy assistant or support worker is performing the activity to an appropriate standard?

Support workers or therapy assistants require a satisfactory level of training and supervision in your child’s needs and the appropriate activities and exercises for them to carry out prior to commencing therapy with your child.  The amount and type of training and supervision required will vary depending on the support worker’s/therapy assistant’s knowledge, skills and competence, the environment, the type of activities, the child’s needs, and the phase of treatment the child is currently in.

Once the support worker or therapy assistant is trained and competent in the activities, then there must be some way for the allied health professional to be able to monitor and adjust the program if necessary, and there needs to be clear and open ways for the allied health professional, support worker/therapy assistant and family to communicate to ensure the program continues to be implemented in a safe and effective way, and to ensure any issues are addressed appropriately and in an appropriate time-frame.  This ensures that the program is being implemented effectively so that your child receives the maximum possible gains from completing the program with the support worker/therapy assistant, that any funding is being used efficiently and effectively, and that your child’s safety is maintained.

Responsibilities:

Allied health professional/ therapist

  • Develop and monitor the child’s overall therapy program (which includes direct therapy and activity/exercise programs completed by support workers/therapy assistants or parents).

  • Develop activity/exercise programs that are safe, effective and within the support worker/therapy assistant’s knowledge, skills and competence.

  • Provide training to the support worker/therapy assistant so they can safely and effectively complete the activities/exercises with the child.

  • Monitor the completion and progress of the activities/exercises being implemented by the support worker/therapy assistant, and adjust as required.

Support worker/ therapy assistant

  • Provide details of their competence, training and experience to the therapist prior to commencing any direct supports to the child so that the therapist can ensure that the activities/exercises prescribed are suited to the support worker/therapy assistant’s capabilities.

  • Complete any therapy activities within their own level of knowledge, skills, competence and training.

  • Immediately stop any activities that are beyond their level of skills and competence, and immediately let the therapist know.

  • Immediately let the therapist know about any other concerns they have with the activities or the child.

Parents/Carers

  • Consider whether the support worker/therapy assistant’s level of knowledge, skill and competence matches their child’s needs prior to engaging them

  • Ensure the support worker/therapy assistant has an appropriate level of insurance to cover any risks related to the activities they will be doing

  • Monitor the support worker/therapy assistant when they are doing any activities or programs with their child, and provide feedback to the support worker/therapy assistant and to the therapist if they have any concerns.

How to choose and engage a support worker or therapy assistant for your child

Under the NDIS, if your child’s NDIS funds are plan managed or self-managed, you have the flexibility to engage any suitable person of your choosing to support your child as a support worker or therapy assistant.  This is a great opportunity to think ‘outside the square’ in terms of engaging someone who fits the needs of your child and family (because there are currently only a limited number of qualified therapy assistants around!).  However, for optimal outcomes, please consider the following points when deciding whether and who to engage as a support worker or therapy assistant for your child and family:

  • Insurance – Does your support worker or therapy assistant have any public liability insurance, business insurance or personal income insurance? If something were to go wrong (and fingers crossed this doesn’t occur for anyone), would there be any insurance available to protect you, your child and family, the worker, or any members of the public?

  • Blue Card – Does your support worker or therapy assistant hold a Working With Children Blue Card?

  • Knowledge, skills and experience – What knowledge, skills and experience does your support worker or therapy assistant have, and are they complementary to your child’s needs?

  • Personality – Is your support worker or therapy assistant a good match for your child and family?

  • Attitude – Are they willing to work collaboratively with you and your child’s therapist/s to ensure optimal outcomes for your child? Is your support worker willing to work within their scope, within the prescribed therapy program as written by the therapist?

Ideas for the successful implementation of a support worker or therapy assistant to help with your child’s therapy program

  • Have a clear agreement between you, your child’s therapist, and the therapy assistant as to each person’s roles and responsibilities within the child’s program of activities

  • Use photos or videos of your child completing the activities or exercises – both to help train the therapy assistant in the implementation of the activities/exercises, but also to provide information and feedback to the allied health professional about your child’s progress.

  • Organise for your support worker or therapy assistant attend therapy sessions or training sessions with the allied health professional to ensure they understands the purpose of the program, has the skills to do the activities/exercises, and understands how to monitor the program within their own scope of abilities. This also provides an opportunity for your child’s allied health professional and support worker/therapy assistant to develop mutual rapport and trust, and will assist with open communication and problem solving between the allied health professional and the support worker/therapy assistant – which will be of benefit to your child’s outcomes in the endJ

If you would like any more information about whether a support worker or therapy assistant might be able to help with your child’s therapy program, please discuss this with your child’s therapists.

References

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