Regional Conference August 2012

Overview 9.30 Registration  9:50. Welcome and Opening Remarks (EF) 10:00 Session 1 –  Disciplinary Processes Overview (ML) 11:00 Morning Coffee 11:15 Session 2 - Revised Scope of Practice Scheme (SMS) 12:30 -1:15 Lunch 1.15 – 2.00 Session 3 – ACC Treatment Data (EF) 2:00 – 2:45 Session 4 – ePortfolio - CPD and Recertification (SMS ).  2:45 Afternoon Tea 3:00 – 4:00 Session 5 The knowledge, skills and attitudes for paediatric

practice (EF)

4:00 – 4:15 Q&A    4.15 Finish

Osteopathic Scope of Practice Reform

Stiofán Mac Suibhne

Section 3 Purpose of the Act

(1) The principal purpose of this Act is to protect the health and safety of members of the public by providing for mechanisms to ensure that health practitioners are competent and fit to practise their professions.

Section 3 Purpose of the Act(2) This Act seeks to attain its principal purpose by providing,

among other things: for a consistent accountability regime for all health

professions for the determination for each health practitioner of the

scope of practice within which he or she is competent to practise

for systems to ensure that no health practitioner practises in that capacity outside his or her scope of practice

for power to restrict specified activities to particular classes of health practitioner to protect members of the public from the risk of serious or permanent harm

for certain protections for health practitioners who take part in protected quality assurance activities

for additional health professions to become subject to this Act

Health Practitioner Competence Assurance Act (2003)

Section 12 Qualifications must be prescribed

(1) Each authority must, by notice published in the Gazette, prescribe the qualification or qualifications for every scope of practice that the authority describes under section 11.

Deconstructing the OCNZ SOP

Registered osteopaths are primary healthcare practitioners who facilitate healing through osteopathic assessment, clinical differential diagnosis and treatment of dysfunctions of the whole person.

Osteopaths use various, recognised techniques to work with the body's ability to heal itself, thereby promoting health and wellbeing.

These osteopathic manipulative techniques are taught in the core curriculum of accredited courses in osteopathy. The ultimate responsibility for recognition of practice lies with the Osteopathic Council of New Zealand.

The Council endorses the following philosophy and principles of osteopathic treatment:

The body is a unit. Structure and function are reciprocally interrelated. The body possesses self-regulatory mechanisms. The body has the inherent capacity to defend itself and

repair itself. When normal adaptability is disrupted, or when

environmental changes overcome the body's capacity for self-maintenance, disease may ensue.

Movement of body fluids is essential to the maintenance of health.

The nerves play a crucial part in controlling the fluids of the body.

There are somatic components to disease that are not only manifestations of disease but also are factors that contribute to maintenance of the diseased state.

Implicit in these philosophies is the belief that osteopathic intervention has a positive influence on the above

Scope of Practice

Scope of the Problem Highly restricted view of practice

Unintentionally placing many osteopaths outside the SoP

Technical and practitioner centric

Failed to communicate skill set

Curriculum focus rather than practice focuses

Why would a patient consul an osteopath?

Why would another healthcare practitioner refer to an osteopath?

Scope of practice = work in progress

OCNZ must specify SoP duty to consult

The debate on Scope

Osteopathy is a weak brand – we need a USP

Field of manual medicine is crowded.

Osteopathy is defined by its philosophy not technique.

Mission creep / Healthcare Ecosystem (professional identity and post modernism)

Stakes a claim for Osteopaths and their role in the healthcare system.

The formless no scope scope of practice is not serving us well.

The formless scope or a restricted scope statement is a form of prohibition.

Discourses on the Osteopathic SOP

Techniques vs philosophy Evidenced based vs Belief - based /

experiential Structural vs Cranial Totality belief system vs regulated

healthcare profession Place of AT Still – legacy of the aphorisms CAM vs Manual Medicine – Orthodoxy /

Heterodoxy?

Discourses on the Osteopathic SOP

Personal / Professional SoP - Differentiated Evolution or Extinction? Modernising = Medicalising? Broad-based with porous boundaries Life long learning vs apprenticeship Tensions and limitations of binary discourse Can’t please all of the people all of the time

NZ Scope Reform

Single Scope of Practice is unrealistic.

Osteopathy is a maturing and diversified profession – needs to be reflected in vocational scopes.

No clear relationship between training pathways and competency in practice: Vocational / Extended Scopes.

30% of NZ Osteopaths were using needling techniques in practice without standards / minimum training requirements being determined.

ACCORB accreditation standards specify no minimum requirements for paediatric practice.

Consensus Position

Additional scopes of practice required to formally recognise skills acquired in post pre-professional training through post-graduate study.

Need to reform the pre-professional training pathway and determine minimum skill set to commence professional life.

Formal training ought not to stop at the point of registration. Externally recognised hierarchy of knowledge

Public register ought to allow patients / third party refers to identify practitioners with advanced standing in certain areas of practice

Multiple Scopes of Practice Act does not prescribe a terminology for scopes of

practice: Vocational & Extended Scopes of Practice

Act does not distinguish between general / extended / vocational SOP

Reference to other NZ healthcare professions

Acknowledging the realities of a maturing profession

Osteopathy at a junctional point

Low quality CPD / lack of career pathways

Diverse pre-professional training pathways

Clinical complexity

Healthcare Megatrends The changing demographic – Western

societies are graying.

Increased demands on resources may mean reduced public sector involvement in direct service provision.

Reduced doctor time will require maximising the services delivered in primary care by allied health professionals.

Need to align the osteopathic scope of practice with the strategic direction.

Globalisation and workforce mobility

Life long learning

New SOP Schema

Patient centred Protection of title Informative to other Healthcare Professionals Broadly defined Simple as possible Allows acquisition / incorporation of PG learning Inclusive

General Osteopathic Scope

Vocational SOPs Extended SOPs Special Purposes SOPs

General Osteopathic Scope of Practice Osteopaths are primary healthcare practitioners

Osteopathy is a person-centred form of manual medicine

Osteopaths conceptualise health and disease within a broad holistic bio-psycho-social and environmental context

Osteopathic practice may be situated within the continuum of healthcare - wellness

The competent practice of osteopathy requires broad diagnostic competencies

Osteopaths work with patients from across the lifespan

Vocational Scopes

Advanced standing and post graduate study / specialisation in areas of practice that remain within the general scope of practice.

There is a continuum of skills / knowledge from novice to expert. Pre-professional training prepares osteopaths to commence practice.

Child health / Paediatrics Gerontology Occupational Health Pain management Rehabilitation Sports injuries

Extended Scopes

An extended scope of practice is required when it is explicit that pre-professional training does not prepare a registrant for competent practice. These areas are excluded from the general scope.

Western Medical Acupuncture Osteopath Prescriber Injection therapies Advanced Diagnostic Competencies

Osteopaths are primary healthcare practitioners

Osteopaths are primary healthcare practitioners. Central to the competent practice of osteopathy is an understanding of the role of the primary care team and referral routes within primary care and to hospital based service.

Rogers, F., D'Alonzo, J., GE. , Glover, J., Korr, I., Osborn, G., Patterson, M., et al. (2002). Proposed tenets of osteopathic medicine and principles for patient care. J Am Osteopath Assoc, 102, 63-65.

Osteopathy is a person-centred form of manual medicine

Osteopathy is a person-centred form of manual medicine informed by osteopathic principles. Osteopathic medicine is not confined to historical osteopathic knowledge; rather osteopathic philosophies and concepts inform the interpretation and application of interdisciplinary knowledge and the basic medical sciences.

Osteopathic medicine is an evolving field of knowledge and incorporates new concepts as our understanding of health and disease progresses.

…holistic bio-psycho-social and environmental context

Osteopaths treat people and conceptualise health and disease within a broad holistic bio-psycho-social and environmental context. Most osteopaths have a particular interest in conditions of the neuromuscular system and the management of pain.

Osteopaths seek to prevent disease, promote health and give patients control over their health by applying the principles of salutagenesis in practice.

Option A

…holistic bio-psycho-social and environmental context

Osteopaths treat people and conceptualise health and disease within a broad holistic bio-psycho-social and environmental context.

Osteopaths have a particular interest in conditions of the neuromuscular system and the management of pain.

Osteopaths seek to prevent disease and promote health by empowering patients through sharing knowledge on lifestyle choices that improve health outcomes.

Option B

Osteopathic practice may be situated within a continuum healthcare and wellness

Osteopathic practice may be situated within a continuum healthcare and wellness, with osteopaths applying evidence based approaches to the management of named pathologies and conditions through to promoting wellbeing through supportive treatment.

The competent practice of osteopathy requires broad diagnostic competencies

The competent practice of osteopathy requires broad diagnostic competencies. Osteopaths employ broad diagnostic competencies and a differential diagnosis is required to determine if a structural diagnosis and the use of osteopathic manipulative treatment (OMT) are appropriate.

Although osteopathic practice is often defined by OMT, the practice of osteopathy it is not limited to a structural diagnosis and OMT. Whilst there may well be a somatic component to disease, OMT may not be a suitable or principal modality in every presentation.

Osteopaths work across the lifespan

Osteopaths work across the lifespan and may treat individuals from birth to old age, or deliver services in group settings.

Professional knowledge may be applied in a range of settings not limited to clinical practice, such as health promotion, education and research, health policy and healthcare management.

Proposed Tenets of Osteopathic Medicine A person is the product of dynamic interaction between

bio, psycho, social and environmental factors.

An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease.

Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness.

The musculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes.

The patient is the focus for healthcare.

The patient has the primary responsibility for his or her health.

Tenets of Osteopathic Medicine

A person is the product of dynamic interaction between bio, psycho, social and environmental factors. The human body functions as unit, with structural and function being reciprocally interrelated between all systems and levels of organisational complexity. Alterations in the structure or function of any one area of the body influence the integrated function of the body as a whole.

An inherent property of this dynamic interaction is the capacity of the individual for the maintenance of health and recovery from disease. Osteopathic medicine views health as the natural state of the body. The health of the individual is determined by complex, self-regulating homeostatic systems that are strongly influenced by the structure of the individual. These regulatory systems are capable of compensatory alterations in the face of disease, yet can be self-healing and restorative when their function is optimised.

Tenets of Osteopathic Medicine

Many forces, both intrinsic and extrinsic to the person, can challenge this inherent capacity and contribute to the onset of illness. A realistic view of health focuses on wholeness, understanding and situating the person in his or her context, and appreciating his or her efforts to maximize health status and cope with disease or disability. Osteopaths recognise that each individual is uniquely vulnerable to stressors that place him or her at risk for loss of health. Illness represents the body’s inadequate, self-regulatory responses to challenges from the internal and external environment.

Tenets of Osteopathic Medicine

The musculoskeletal system significantly influences the individual’s ability to restore this inherent capacity and therefore to resist disease processes. Historically orthodox medicine has conceptualised health and disease primarily in terms of internal organs and their disturbances, the musculoskeletal system being relegated to a secondary role as an organ system that is primarily related to locomotion.

Osteopathic medicine considers the musculoskeletal system to play a primary role in health and disease. Derangements in the musculoskeletal system are common and represent significant public health concerns. Abnormalities in the structural system affect its function and that of related circulatory and neural elements. The interventions directed to the musculoskeletal system include osteopathic palpatory diagnosis and manipulative treatment, therapeutic and recreational exercise, and physical therapy modalities.

Tenets of Osteopathic Medicine

The patient is the focus for healthcare. Osteopaths are trained to focus on the individual patient and resit reducing the focus to the abstractions of presenting symptoms, body parts and named disease entities.

The relationship between clinician and patient is a partnership in which both parties are actively engaged. The osteopath is an advocate for the patient, supporting his or her efforts to optimize the circumstances to maintain, improve, or restore health

Tenets of Osteopathic Medicine

The patient has the primary responsibility for his or her health. Although the patient-osteopath relationship is a partnership, and the osteopath as a healthcare professional has obligations to the patient, ultimately the patient has primary responsibility for his or her health.

The patient has inherent healing powers and must nurture these through diet and exercise, as well as adherence to appropriate advice in regard to stress, sleep, body weight, and avoidance of substance misuse.

Prescribed Qualifications Vocational scopes

Interdisciplinary – using existing resources Formal Learning & Learning in Clinical

Settings Accessibility – mixed mode delivery Creative learning pathways Defining / Refining Capabilities Patient safety Career Development Responding to changing healthcare

environment Liberal CPD Regime for Vocational SOP Holder

Vocational scopesIn order to apply for registration in a vocational scope of practice the osteopath must hold a prescribed qualification, be registered in the General Osteopathic Scope of Practice and have held an annual practising certificate for three years.

Suitably qualified overseas applicants will be considered if they have been registered and practising as an osteopath in an overseas jurisdiction for 3 years. Review if elective pathways.

Vocational scopes of practice are drawn from key areas of osteopathic practice and will allow registrants to pursue career development aspirations and hopefully improve the quality and relevance of professional development activities.

The healthcare needs of the population are changing and it is important that the scope of practice framework is such that it guides the development of relevant professional knowledge and skills.

Gerontology In the midst of the demographic changes it is important

that healthcare provision considers the needs of older patients and seeks to work with then to maximise their health and quality of life.

If the healthcare system is to rise to the challenge of meeting the healthcare needs of an ageing population it is important that healthcare professionals develop the necessary skills and knowledge to help maintain independence and health seeking behaviours in older patients.

A vocational scope for gerontology will signal to older patients that the osteopath has a particular interest and advanced knowledge base that supports this area of their practice.

Gerontology

The centrality of the patient to models of practice within the osteopathic paradigm, a conceptual framework that places the patient within their own context and seeks to maximise health within a structural-functional continuum make osteopaths particularly well suits to working with older patients.

Protection of Title: Osteopaths registered in the Vocational Gerontology Scope of Practice are entitled to use the title of Osteopathic Gerontology Practitioner

AUT Post Grad Cert Health Science - Older Adult Health and Wellness

Postgraduate Certificate in Health Science in Older Adult: Health and Wellness (AK3484) 60 points

 The PgDipHSc provides you with the opportunity to undertake an approved course of study to advance your specialty discipline, knowledge and scholarly development. This programme comprises three 20-point papers, which can contribute 120 points towards a , Master of Health Science or Master of Health Practice.

Core Papers:Contexts of AgeingCognitive Health in AgeingResearch Methods Reflective Practice

 Electives:

Exercise PhysiologyScience for Advanced PracticeEnhancing Muscular PerformanceApplied Human Movement StudiesMotor Control in Rehabilitation Concepts of RehabilitationParticipation in HealthStroke Management

Pain ManagementThe management of pain is key professional interest for many osteopaths.

Although osteopathy was initially conceptualised as a drug-free therapeutic system, in the intervening years more effective and less toxic drugs have emerged and professional knowledge of such developments is required.

In addition pain management as an area of practice has developed a rich body of interdisciplinary knowledge and practice.

Pain ManagementThis vocational scope will allow those that have a particular interest in working with chronic pain conditions to be identified in the register and be given credit for their further studies.

 Protection of Title: Osteopaths registered in the Pain Management Scope of Practice are entitled to use the title of Osteopathic Pain Management Practitioner.

Gerontology

The centrality of the patient to models of practice within the osteopathic paradigm gives a framework that places the patient within their own context. Ageing / death not prominent within AT Still’s thinking?

Seeks to maximise health within a structural-functional continuum make osteopaths particularly well suits to working with older patients.

Protection of Title: Osteopaths registered in the Vocational Gerontology Scope of Practice are entitled to use the title of Osteopathic Gerontology Practitioner

Univ of Otago School of Medicine Muscular Skeletal Medicine Programme

The endorsement in Pain and Pain Management is open to medical practitioners and allied health care professionals and can be studied part-time / by distance.

It is designed to present an understanding of the importance of pain to the individual and to society, and how best to optimise its management.

It provides candidates with the necessary skills to better understand and manage pain problems that pertain to their particular discipline within health care. At Master’s level, it provides a knowledge and understanding of research methodology and its practical application

Pain Management

Psycho-social Aspects of Pain Introduction to Pain Introduction to Pain Management Pain Assessment Neurobiology of Pain Biomedical Pain Management Pain in Special Circumstances Musculoskeletal Rehabilitation Cognitive Behavioural Therapy

Post Grad Diploma

Child and Infant Health

As entry level / minimum standards have yet to be developed for paediatric practice it would be previous for Council to develop a vocational scope for this area of practice.

By determining a set of knowledge, skills and attitudes for competent paediatric practice the Council will be meeting its obligation to ensure competence frameworks are developed. This will help ensure one of the most vulnerable patient groups is protected.

Professional practice needs to be informed by risk management strategies, be situated in contemporary understanding of normal child development developmental and adequate knowledge of congenital and developmental disorders in children.

Special Purpose SOP

The Osteopathic Council recognises that osteopathic practice is not limited to the direct provision of clinical services to patients. Osteopaths may use their professional knowledge in a wide range of settings:

Direct non-clinical relationships with patients; such as in group exercises programmes, health promotion activities or health care systems administration (ie working for ACC as a case manager or doing clinical audit).

Clinical educators / clinical preceptors; in pre-professional teaching clinics or practice based settings

Research – undertaking or directing research activities

Teaching – faculty working in the tertiary sector on professional qualifications leading to registration as an osteopath or other regulated health profession and post graduate osteopathic / health science programmes.

Policy development and regulation

Visiting Osteopathic Presenter / Educator

Where to from here?

Consultation on Gerontology / Pain Management SOP Gazette notices

Building partnerships with stakeholders – Interdisciplinary learning pathways

International considerations – USA

Integrate with CPD / Recertification