Developing Occupational and Physical Therapy in Haiti:

Inter-professional and International Collaborations

Julie Booth, PT, DPT, PCS Quinnipiac University

Introduction

1. Understand the complexity of developing culturally relevant health care baccalaureate programs in an under-developed country.

2. Describe the importance of inter-professional education to build programs in an under-developed country.

3. Appreciate how universities can work collaboratively to share resources and ideas.

Context: REHAB in Haiti

HISTORY Ancient culture from Africa Uniqueness of formation: Idealism Law of 1787 following the successful revolution that

provided financial security and social access for veterans with disabilities resulting from the battles

World Isolation Natural disasters Internal struggle, external domination

St. Vincent’s Center/Rehab training

Fast Forward to Recent times In 1945 Sister Joan of the Episcopal Order of St. Margaret,

Boston, started the first school for children with disabilities: St. Vincent’s Center, still active today.

Approximately 1999: rehab technician training programs Over 200 technicians

Haitian PTs : education in Dominican Republic, Cuba, Venezuela 50 PTs

One Haitian OT: double-certified in PT and OT from the DR

Bureau for the Secretary of State for the Inclusion of Person with Handicaps

Bureau for the Secretary of State for the Inclusion of Persons with Handicaps (BSEIPH): 2007 Dr. Michel Paen Mr. Gerald Oriol Jr

Gerald Oriol Jr- Recent Secretary of State for the

Inclusion of Persons with Handicaps

Haitian complexity

TODAY 70% under age 30 Crowded Vibrant art & music Bilingual Kreyol and French Increasingly adding English Education valued, but excellence hard to find Social organizations of Haitians for Haitians

Social organizations collaborating

EARTHQUAKE Jan. 12, 2010

Great numbers of survivors with amputations, spinal cord injuries, traumatic brain injury, post-traumatic stress disorder

Rehab technician recognition sought (3 programs active)

Society of Haitian PTs – approximately 2012 Association of Haitian OTs - Nov 2015 Floods of rehab volunteers 10,000 NGOs counted in Haiti after the earthquake Presence and then withdrawal of many rehab agencies

EARTHQUAKE Jan. 12, 2010

EARTHQUAKE Jan. 12, 2010

EARTHQUAKE Jan. 12, 2010

Bureau for the Secretary of State for the Inclusion of Person with Handicaps

BSEIPH authored the Law of 2012 : • mandating universal accessibility for new

government buildings • hiring quotas for persons with disabilities for

large companies • universal education

World Federation of Occupational Therapy

Length of program: 3-4 years Preparation of students entering WFOT Minimum Standards for essential knowledge Look to other curriculum and standards WFOT, Advice for the establishment of a new programme for the education of occupational therapists (2004).

World Confederation of Physical Therapy

Length of program: 4 years Deliver a program that will enable graduates to be

autonomous practitioners WCPT guideline for physical therapist professional entry level

education Look to other curriculum and standards Consider unique factors in a country or region that will

influence PT practice and education WCPT guideline for physical therapist professional entry level education; WCPT Policy statement (2014)

WFOT Entry Level Competencies

Context in which services will be provided

•Nature of local health needs

•Local health and related systems

•Relevant health giving occupations

•Program philosophy and purpose

Generic Competencies = Identified

competencies framework

•Knowledge •Skills •Attitudes

Specific Competencies match each national

need and environment

•Person-occupation environment relationship

•Therapeutic and professional relationships

•Occupational therapy process

•Professional reasoning and behavior

•Context of professional practice

Settings where the services will be provided

•Community •Hospital •Private and

public practice •Tele-practice •Education •Recreation •Research •Policy, industry,

etc.

WCPT Entry Level Competencies Context in which services will

be provided

•Provide services to: develop, maintain, restore maximum movement and functional ability throughout the lifespan.

•Services are provided in circumstances where movement and function are threatened.

•Program philosophy and purpose

Generic Competencies = Identified

competencies framework

•Knowledge •Skills •Attributes

including: •Life long learner •Commitment to

the profession •Interprofessional •Humanistic •Service oriented •Ethical •Critical thinkers •Reflective •adaptable

Specific Competencies match each national

need and environment

•Physical Therapy Process

•Therapeutic and professional relationships

•Professional reasoning and behavior

•Context of professional practice

Settings where the services will be provided

•Community •Hospital •Private and

public practice •Tele-practice •Education •Recreation •Research •Policy, industry,

etc. •Primary health

care •Urban and rural

communities

Context, context, context

Context Needs of Haiti – Critical thinking, primary care role,

leadership, advocacy Realities of health care system Existing rehab assistant programs

Specific to the Episcopal University Needs of the program – faculty, language, block

schedule, online learning, course resources. Resources, personnel, credit hours, policies Opportunity for inter-professional learning

Institutional Capacity

Leadership Personnel Calendar year Degree conferral

Resources Credits Grading

Sample Schedule Courses Sept. 2018 Oct. 2018 Nov. 2018 Dec. 2018 January 2019 Feb. 2019

Pathophysiology I (OT/PT)

Health and Wellness (OT/PT)

Imaging (OT/PT)

Professional Issues in Haiti (OT/PT)

Wound Care (OT/PT)

BREAK Holi- day

clinical seminar (OT/PT)

Level I Clinical Practicum 3 weeks

English Computer Science

French Conversation

Final Exam Week

Tensions and Challenges

Who defines what OT/PT should look like in Haiti? United States? Canada? Cuba?

Dominican Republic? Trinidad and Tobago? People with disabilities in Haiti?

Haitian doctors? Haitian physical therapists? Haitian occupational therapists?

Development of Clinical Education

Clinical Education Guidelines: World Federation of Occupational Therapy (WFOT) World Confederation of Physical Therapy (WCPT)

WFOT Minimum Standards

• Congruence • Depth & breadth • Minimum of 1,000

hours • Supervisor must have

at least 1 year of experience

• Local context • International

perspective • Quality

improvement

WCPT Minimum Standards

• Congruence • One-third of the

curriculum • Progressive experiences • Range of settings across

lifespan • Clear policies and

procedures

• Supervisor criterion: members of the member organization, 3 years of experience, and post professional qualification in PT

Clinical Education SWOT Analysis

Strengths Haiti OT & PT Associations Recognition by the

Caribbean OT Association Well-rounded clinical

experiences Demand and need for OT

& PT services Accreditation with WFOT Seeking accreditation

with WCPT

Weaknesses Site availability with

qualified supervisors Logistics Lack of mentors for

fieldwork supervisors Language Cultural competence

Clinical Education SWOT Analysis

Opportunities University partnerships Educating & empowering

future supervisors & educators: Clinical Education Conferences and Continuing Education

Student-run clinics Networking with

professional associations

Threats Stability Funding Future employment International perspective

Faculty development: resources

US Department of State U.S. faculty and professionals to serve as expert

consultants on curriculum, faculty development, institutional planning, and related subjects at academic institutions abroad for a period of 2 to 6 weeks

Fulbright Specialist Program

Project support critical priorities identified by the host institutions and supported by U.S. embassies and bi-national Fulbright Commissions abroad

Host institutions can initiate the process to apply for a Fulbright Specialist by contacting their local Fulbright Commission or in-country U.S. Embassy

https://exchanges.state.gov/us/program/fulbright-specialist-program

Fulbright Specialist - Haiti Janet initiated the grant process through the US Embassy in

Haiti Academic and Exchange Programs Manager Public Diplomacy Office

Once approved, US Dept. of State arranges travel and stipend, host institution responsible for accommodations

GOALS for Haiti Grant: Match international faculty to specific courses in the

FSRL curriculum Assist with development of new educational model Assist with development of Ethics Committee

Ethics Committee Body of individual who ensure that human research is

carried out in an ethical manner **Different from Institutional Review Board (IRB)

Advisory capacity to institution Review potential research proposals to assure the

research is 1) culturally relevant and 2) beneficial to the participant and the community

World Health Organization (WHO) Ethics and Health Unit Department of Ethics, Equity, Trade and Human Rights. (2009). Retrieved from http://www.who.int/ethics/Ethics_basic_concepts_ENG.pdf

Summary Overwhelming need for OT and PT in Haiti

Environment is very open for rehabilitation specialists Important to graduate students to be leaders in the OT and

PT fields Especially critical for new graduates to advocate for OT

and PT services Educational models - important for programs to be culturally

relevant and flexible to opportunities and partnerships

Summary

Clinical Education - be realistic about resources and maximize partnerships for clinical education

Faculty Development - look for various sources to support faculty development and volunteer instructors

Consider development of an Ethic Committee early in program development

**“Field of Dreams” concept

Contact Information

Kate Barrett, kbarrett@stkate.edu

Julie Booth, Julie.Booth@quinnipiac.edu

Patty Coker-Bolt, cokerpc@musc.edu

Jami Flick, jflick1@uthsc.edu

Janet O’Flynn, dean@haitirehab.org

janetoflynn@Hotmail.com