Monday, July 7, 2008

Discussion on Specialty Certifications

RESNA Specialty Certification Feedback

In preparation for creating specialty certification programs the PSB is interested in your assistance in identifying areas of specialty practice within AT and the distinct knowledge that defines that area of practice.

If you would like to provide us your feedback regarding specialty certification, you may fill out this form online, save it, and submit it to Anjali Weber, Director of Certification at aweber@resna.org.

1. What specialty certification would you most like to see implemented?

2. What are the pros of instituting this particular specialty certification?

3. What are the cons of instituting this particular specialty certification?

4. How will a specialty certification positively or negatively affect your job function?

5. Describe how expertise should be demonstrated in this specialty area?

If you are willing to assist the PSB in the development of a specialty certification email aweber@resna.org include your name, phone, email and specialty area.

POST #7- Response to comments 6/23-7/7/08

Q: I joined RESNA and achieved the ATS certification about 5 years ago. At that time, I agreed and pledged to the RESNA Code of Ethics and Standards of Practice. That RESNA Code of Ethics and Standards of Practice statement in a nutshell states that as a certified ATS, ATP or RET that you will practice within your scope of expertise and hold the consumer's best interest paramount at all times. I am supportive to the advancement of the program by which RESNA administers all of our certification. For example, at some point many years ago, a person could achieve the title of "doctor". In these early times, a person would go to a "doctor" for a broken leg, being unconscious, an infection or blindness. Now that medicine has made a few advancements, if we have a medical problem, the routine is quite different. We might see a "doctor" at first. However, we are likely to be seen and ultimately treated by a cardiologist, orthopedist, ophthalmologist, etc - depending on what our ailment is. This is no different. Our field is growing, expanding and advancing. We absolutely need to expand and offer additional certifications to illustrate various areas of specialty or expertise. I am sure that at some point up-and-coming physicians didn't want to have to "take another class or exam" either - but they did and now they are recognized for their efforts and I think we all agree those specialties are necessary divisions in the field that we can all appreciate.As an industry, we need to continue to police ourselves. Support of Medicare's company accreditation ruling and employee certification ruling is one way that we have stepped in the right direction. Now that RESNA is in the process of making this program more appropriate and making this program respectable, it is time that all of us that are currently certified, whether an ATS or ATP, support their efforts. Certification and/or RESNA membership is voluntary. If you don’t want to participate in the furthering of the industry, then please stop posting negative comments. Negative comments only make our industry look more divided. It certainly gives us the reputation of "they wanted certification while it was good for them" and "they are for consumer protection and quality standards until it might affect their wallets". I think that those of us that are committed to this industry and this certification for the long haul can only be appreciative and supportive of this proposed change.I happen to be a person that has taken some extra classes and made an extra effort to focus and specialize on some computer access and environmental controls. It is interesting to see how many ATS and ATP certified individuals try to practice in this area without experience or focused education. I have repeatedly had to go behind these individuals and "clean up". Almost every time, the culprit has been an ATS/ATP that provided that client with a wheelchair and then tried to practice in an area outside their normal scope (anonymous)

A: The intent of the RESNA certification program is to identify individuals with a core competency in AT. While it has been used in policy to determine who is needed to provide what service, it is currently not a specialty certification in any particular area of AT. This baseline certification, while it demonstrates an overall general knowledge of AT practice areas, does not itself identify competency in a particular area of AT. A current ATP practicing in seating and mobility likely does not have the experience or background to do an evaluation for computer access, for example. Recognition of specialty knowledge will be important to determine a specific area of competence in some practice settings.

Q: As an ATP, I felt the exam was a challenge however equally weighted. I wouldn't recommend changing a thing! Sheila

A: Because the content of both ATP and ATS tests is weighted across the various areas of AT practice, and this content is the same for both exams, certification with two different pathways, testing the same core knowledge, and defined by roles, cannot continue as it is without either combining or creating further differentiation in knowledge base. The current validation study conducted by RESNA’s PSB, along with the feedback received, will focus the test blueprint and distribution of items.


Q: What is wrong with the current ATP/ATS certifications? This change seems like it could be money driven, as I would believe a majority of the experts have already taken and passed the exam, and we would all be required to attend further training workshops and sit for exams, right (anonymous)?

A: All current certificants would maintain their certification and be transferred to the new designation without cost – it is an administrative process. There is no need for further testing unless someone wants recognition of further specialty knowledge in AT. This also can be done in other ways besides exams, such as continuing education. We welcome your feedback on development of specialty certification by posting your comments on our website at http://www.resna.org/content/index.php?pid=108 (Certification/Announcements section)

Q: There is a lot of information to think about but my initial reaction is frustration....having said that I absolutely agree with the one who wrote that you might consider a vote of the membership. How many of those making the decision on this are actually practicing in the community and truly experience this on a daily basis...who is getting confused with ATP/ATS? You mention that your goals are in line with Medicare etc....Shouldn’t they really be in line with what’s best for our clients? However, from what I hear, you have already made your decision and no "blog" will change your mind...why bother with this blog? I feel it’s just a way to "break it to us slowly with less backlash (anonymous).

A: RESNA will not proceed without carefully examining all issues and comments posted. The reason for the change is not dictated by policy. The RESNA certification program was implemented 12 years ago to identify AT as a specialty area of knowledge. In review of the current program, we find that certification delineated by role is stepping beyond the purpose of certification – it is not meant to imply who has permission to do what, as licensure does.

The other goal of certification is to protect the consumer and to help them find qualified people. This is difficult when lines blur, roles change, and people are not able to tell who specializes in what area of practice. As the current certifications test a baseline knowledge in AT but not a sub-specialty in seating and mobility, or computer, access, or the many other areas of practice, it is not possible in the current program to really identify the person to go to for a particular service. This will be dictated primarily by their current employer, their licensures, and other formal training. This is also why specialty recognition is important to help the public identify further knowledge in a particular area. The current certification helps to identify individuals who have a baseline knowledge demonstrating awareness of other areas of AT and how it impacts their recommendations, and when to refer elsewhere, and it lets all of these individuals speak in a common language.

Q: What is wrong with having someone who is an ATP that wants to switch to ATS just take the 50 questions that designate them as an ATS. Then you could have an ATS/ATP designation. I have always thought that the test should have a general knowledge section, and then the individual could choose to take what ever specialty section that they choose. I personally don't work with Aug Com, but I still have to test on it. I know mechanics do that for their certification. They have separate tests for brakes, engines, and so forth. I just think instead of combining everyone in to one group, it would be better to divide it up into specialties. Also it would be easier to determine what areas people specialize in.

A: The current exam tests the core AT knowledge in many areas of AT. Currently, the 50 exam questions that differ between ATP and ATS exams are not differentiated enough to identify a separate core knowledge, and the certification implies a role and permission to do something, which steps beyond what certification’s true purpose should be. We agree that there needs to be a method to identify further specialty knowledge in particular areas of AT, and this is why specialty certifications are being considered, with the first one developed for seating and mobility. In some practice settings, however, there may be a need for specialty knowledge in other areas of AT practice, such as in special education or job accommodation, where many technologies are used. For some, the baseline certification will be sufficient to identify the broad AT knowledge, and for others, it may be important to further define specialty knowledge. We are looking for this feedback and welcome your input at http://www.resna.org/content/index.php?pid=108 (Certification/Announcements section)

Q: This in not meant to be a question. This just seems to be the only place to voice my opinion. I agree with what RESNA is looking to do. There are many complaints coming from both ATP and ATS certified professionals about the content of their exams, which is exactly why I think there should be one entry level exam. From my understanding, the current questions for the ATP and ATS tests come from the same question pool with a higher percentage of questions from certain subjects at the end, depending on which test is being taken. If this is true, then we are both taking tests with the same questions anyway. I am hoping RESNA intensions are what I think they are which would be to make sure everyone certified can communicate in all areas of AT at a basic/entry level, before moving forward. My vote is for combining ATP and ATS to create Assistive Technology Professionals Allow all Assistive Technology Professionals to sit for the RET examAllow all Assistive Technology Professionals the opportunity to specialize in areas of interest Evaluation and AccessibilitySeating and MobilityTechnicianAugmentative Communication

Q: I am an OT with over 20 years experience in Rehab and AT. I was in the second group to take the ATP exam in New Orleans, and passed it. 10 years later, I didn't renew it, because at the time, there was no advantage professionally for me in my role as a staff OT at the hospital where I worked. I subsequently started working for an equipment vendor part time, and re-tested and passed again to renew my ATP, which they felt I needed at the time. I since have gone back to full time at the hospital, and have allowed my ATP to lapse. I did this mainly because of the expense and hassle to renew yearly, and because working for a hospital as a therapist, I saw no advantage to maintaining the ATP certification. The hospital is not generous with continuing education funding. I already maintain State licensure, and National certification for OT. I guess if I were going to work for a vendor, or a manufacturer, or give presentations on AT, I would probably take and pass the test again, but for right now, it's not for me. Make it easier for me to maintain it, and I might renew it again.

A: RESNA’s PSB is taking active steps to change the certification renewal requirements and is currently reviewing the criteria. Changes under consideration include a move to a 2-year certification period, broadened criteria for acceptable continuing education, and an opportunity to put certification under an “inactive” status when changes in employment, family situations, and more may make this option desirable, and a policy for reinstatement when a certification has lapsed, depending on the circumstance. These changes will be broadly posted with sufficient time for implementation when they are finalized.

Q: I have concerns about blurring the line between a vendor and a practitioner. Consumers and funding sources need to know that a professional therapist is making a recommendation without conflict of interest. Using the same credential will make the distinction less clear. I do support specialty certification, as we cannot possibly be competent in all the areas of AT.

A: Our intent is not to blur the lines, but to go back a step to remove the implication of role to the certification. An individual’s credentials include their degrees and their licensures, as well as certifications in different areas. A therapist already has that license to designate what they are able to do under their practice acts and under the law. It is also our responsibility to work with the industry in helping to affect policy and to recognize what is needed for quality practice in AT service delivery.

Q. I believe that there are many organizations who do know the difference between ATP and ATS, and will be more confused after seeing new changes. I do agree that there should be specialty areas within each credential, but am against combining the two certifications.

A.Tying roles to certification titles overstep the purpose of certification. RESNA must be careful to promote the certification program for what it is – demonstration of a baseline competency in basic AT knowledge. A unique body of AT knowledge has not been identified between the ATP and ATS exams - both exams are created from the same test blueprint. Therefore there is inadequate differentiation in knowledge between the two certifications to justify two different certifications.

We agree that specialty certifications are the right next step to differentiate those with specialty knowledge in a specific area of AT practice. RESNA has engaged marketing consultants to assist in developing materials that can be used by RESNA and certificants to increase the visibility and public awareness of the RESNA Certification Program .

Tuesday, June 24, 2008

POST #6: Responses to Comments 6/22 to 6/23

Q: I agree with the comment on continuing education certificate classes instead of examinations. The ATP exam experience taught me nothing new whereas the certificate program in assistive technology from University at Buffalo taught me a great deal. This credential had been a goal of mine for the 3 years it took me to have enough experience time to take the test. However, taking the test made no difference on how I work with patients and determine needs. Whereas continuing education always curbs my knowledge base which allows more informed choices for patients(anonymous).


A: The RESNA certification is intended to identify individuals who have a combination of education, AT work experience and demonstrated competency in basic AT knowledge. We agree that a certification program is very different from a certificate program. The latter is designed to be educational. At the completion of a certificate program students usually take a test – usually one of the following - a knowledge test, skills based practicum, or portfolio review. Upon successful completion of the curriculum and course requirements students are awarded a certificate of completion. RESNA will consider different venues for demonstrating competence in a specialty area in AT, including establishing certificate programs as there is interest and demand.

Q:
In response to the PT's comment on the exam ... The ATP exam I took was equally divided between seating and wheeled mobility, augmentative communication, and computer access. This is not fair to physical therapists, speech therapists, and non-therapists. It seemed clearly geared to occupational therapists more so than any other field. Did you look at by profession who has a higher pass rate? This might give you more data than trying to compare apples to oranges between DME providers and practitioners. It hasn't ever made logical sense why 3/4 of the exam between the two exams is the same. The answer is not to make it all one exam but instead to clearly differentiate the two exams with questions that meet the needs of each type of role. People who switch back and forth in their careers should be able to clearly see a difference in their roles through the certifications and see the value in their chosen separate career paths (anonymous).

A: The current ATP and ATS exams were created based upon a job survey that was distributed widely to individuals working in all areas of AT. The job analysis or results of the job survey was the basis for the ATP and ATS test blueprint that dictates the test content domains and number of items needed for each domain. Therefore the ATP and ATS exams were designed to reflect general AT practice and were not created to favor one profession or area of AT practice.

It is not the intent of a certification program to qualify an individual to perform a specific role. Tying our certifications to specific roles (practitioner and supplier) has caused confusion as people change employment and roles, though the original intent was to help the public identify who could provide what services. A voluntary certification should not be tied to specific roles, and our research and discussion with our consultants verifies that other programs use certification to identify competence in a core knowledge base, while regulations define who can perform what role. This is why in other fields, once a certification is earned, it can still be retained if the eligibility requirements are still met for renewal (i.e. continuing education), even when the person is not practicing or changes employment. It is the duty of the PSB to ensure that the RESNA certification program only claims what it is and does not overstate what a certificant is able to do. This is the motivation for the move to one basic level AT certification.

Q: I have concerns about blurring the line between a vendor and a practitioner. Consumers and funding sources need to know that a professional therapist is making a recommendation without conflict of interest. Using the same credential will make the distinction less clear. I do support specialty certification, as we cannot possibly be competent in all the areas of AT (anonymous).

A: This is another reason to move towards establishing a single certification. Funding sources will know when a qualified therapist is making a recommendation from their license to practice PLUS the certification. One example of the current lines being blurred is when a therapist changes employment to work for a supplier. To keep the ATP is confusing to the general public because it IMPLIES a role of an independent assessor with no financial ties to a recommendation. A certification is to demonstrate competency in a specific scope of knowledge and is independent of a role. That is why in other certification programs once an individual earns the certification it stays with them no matter what their job – there is no need to change certifications. It is our intention to separate role from competency with the change to a single certification program to represent the scope of what the RESNA certification claims – competency in basic AT knowledge. It is imperative that we do not overstate the meaning of the certification which happens when we tie certification to roles.

Q: Why Now? Medicare has made ATS & ATP the gold standard for our industry just recently! ATP staff employed by hospitals that have deep pockets will be fine. I think all ATS staff should ask their home health companies how committed they are to staying in wheeled mobility with competitive bidding or, 9.5% Medicare allowable cut across the board facing them. We all know the hidden cost of providing complex rehab. I know of 2 companies in my area that have stopped providing complex rehab already.
Don’t put one more straw on the camel’s back at this time. Give competitive bidding or the upcoming slash to allowable to be fully digested. This will hurt smaller HME companies that currently provide excellent complex rehab equipment and their customers who depend on their service. The waters are turbulent and we don’t need our own industry adding to the stress. Please read these posts of concern and keep an open mind…
This is a great idea but, NOW IS NOT THE TIME (anonymous)

A: We do not propose to make this change without transferring current successful certificants to the new designation without charge, so there is not an additional financial burden or stress. The goal is not to put undue burden, but rather to simplify and reduce confusion. We agree that this is an especially difficult period in the industry, with competitive bidding as well as policy changes. Smaller companies would not be affected by a change in certification, though competitive bidding will affect many businesses significantly. RESNA is involved in the industry effort to minimize the effects of competitive bidding and to carve out complex rehab.