Ep #105: Beyond Delegation: Rethinking the Rehab Assistant Model

Episode 105, Beyond Delegation: Rethinking the Rehab Assistant Model.

Welcome to Clinicians Creating Impact, a show for physical therapists, occupational therapists, and speech-language pathologists looking to take the next step in their careers and make a real difference in the lives of their clients. If you’re looking to improve the lives of neurodiverse children and families with neurological-based challenges, grow your own business, or simply show up to help clients, this is the show for you. 

I’m Heather Branscombe, Therapist, Certified Coach, Clinical Director, and Owner of Abilities Neurological Rehabilitation. I have over 25 years of experience in both the public and private sectors, and I’m here to help you become the therapist you want to be, supporting people to work towards their dreams and live their best lives. You ready to dive in? Let’s go.

Hi there, friend. I hope you are doing well. If you are listening to this episode when it’s first coming out, this is kind of end of spring for me, beginning of summer. I’m recording this at the beginning of June. And this month, I am doing even more connecting with clinicians from all over, both in external meetings, external committees, as well as some hiring that we actually have going on. And I have to say, it is super fun to hear and share the common passion that we have in essentially just helping people.

So this month’s episode is a little more personal. It’s personal to me, but it’s also foundational, and I hope it’s personal to you as well. I want to talk about something that’s often seen as maybe a more logistical tool, but for me and for us at Abilities, it’s actually much more deeply philosophical. And that is our model in which we use rehabilitation assistants or what I’ll call the rehab assistant model, for short.

So, fun fact, the first person I ever hired at Abilities, other than myself, was actually a rehabilitation assistant, and she actually still works with us to this day. So, I just want to share that because delivering high-quality care with rehabilitation assistants is super and deeply important to me. And I think that this model and thinking about rehabilitation assistants is really important in this time of our industry and area of practice because first of all, therapists are burning out. It’s really just the truth. Never in my 28-year career has there ever been a time that we have said that there are too many therapists. And so, because there’s this kind of chronic shortage, no matter what the area that you clinically work in, there’s always this idea that the work may never be enough or your work is never enough to actually meet the needs that’s what’s out there.

And secondly, clients really do need more access to care. Certainly, the needs that our clients and/or patients are expressing are not decreasing. And then thirdly, funding models are ever-evolving, and ultimately, we need a more sustainable, team-based approach that is informed by our expertise and not just a system that uses our expertise after the fact.

So today, what I want to share is really part vision, part system, and really a part invitation for you. But before I share more, I know that you may already know this, but this podcast is a passion project of mine because I want all clinicians to have the ability to use this kind of toolset and tips as a way to magnify their own impact, even if they never work either alongside us or with us at Abilities. I really do consider myself so lucky to be able to do this kind of sharing and to share this as part of my work week. It’s kind of awesome.

So you can help me make this more meaningful and more impactful by helping to share the message. Because the truth is, more engagement helps more clients and more clinicians. So let’s work together to make that happen. So practically, you can help me to do that in a couple of ways. One, if you could please take a little moment, it probably takes you 30 seconds or less, follow, rate, and review this podcast wherever you’re listening to it. That helps feed the algorithm. So, when there is a clinician just like you, this podcast will come up for them. And then secondly, if you can personally share this podcast or, even better yet, a favorite episode with a colleague, that’s even more impactful.

So, if you have heard this before, meaning this invitation, and maybe even meant to do it but you haven’t done it yet, it’s okay. I say this all the time. It really is okay. But maybe today’s the sign. Let today be the day that you can help other clinicians just like you. And if this is your first episode, I will say, welcome. Thank you so much for listening, and hopefully, as you listen, you can decide who of your clinical besties you would love to hear more of this kind of information to help them at work as well.

So, thank you so much in advance for your action here. And with that, let’s get back to the episode.

So, let’s talk a little bit more about the problem as we sometimes see it with rehab assistants. So, one of the problems is that all of our training as we become clinicians is really designed to be at that entry level. And so, it makes sense that so many of us don’t come out of school feeling competent and confident in using rehabilitation assistants as part of our treatment plan. And so, often delegation in therapy can look something like, “I don’t have time, so I’ll hand this off to a rehab assistant.” And what I’ve seen is in many clinics or other organizations, rehabilitation assistants are often undertrained or underutilized.

Now, I know it’s not intentional. But it really does create a dynamic that isn’t ideal. It creates this dynamic where there is inconsistency for clients or patients. It creates a dynamic that is actually more stressful for therapists or other clinicians. And often, there’s this perception that assistants are just, quote-unquote, “helpers” and not actually an integral part of the team.

So this is the problem we’re looking to change at Abilities as part of our mission. But we believe that delegation should be intentional, empowering, and strategic. So, to kind of share a little bit more about our philosophy, the truth is that at Abilities, we don’t just use rehabilitation assistants; we develop them. That’s the mission and vision that we’re working towards. And there are really three core beliefs that really shape how we work.

First, continuity matters, especially for clients with neurodiversities or neurological-based challenges. Because, like many of us, I know that I do, we typically thrive on routine, we thrive on familiarity, and we thrive on relationships. So that continuity really does make a difference. And secondly, we have a core belief that quality is teachable. So when we create clear expectations, ultimately, we can reduce the risk and increase the confidence for everybody involved. And thirdly, collaboration expands capacity for everybody.

So, using rehabilitation assistants isn’t about cheap labor; it’s about sustainable impact. This kind of model lets us all grow without losing the heart of our care.

So, I know that as a clinician myself, back in the day, when I had a young family, I had a lot of needs, both personally and professionally. I often felt torn. But I had this belief that, all things being equal, a client would actually prefer to work with a therapist or another kind of entry clinician versus a rehabilitation assistant. And so what I would think is, if money wasn’t an issue, that they would choose a therapist all the time. But the reality that I actually saw once I started testing that belief is that it actually isn’t true. Ultimately, people want to work with other people that they connect with who can help them to reach their goals.

So, I have to say, it’s been humbling as a therapist to have clients prefer to work with a rehabilitation assistant over myself. I mean, again, there’s some ego that I had to get over, but I got over it. And by getting over it, I was able to find a way to better meet both my own needs, personally and professionally, and my clients’ needs as a sustainable way to grow the impact that we created for myself, for our clients, and those around us. I mean clients, colleagues, organizations, and the community that we’re serving.

So, how do we do it? Without diving into all of the things, that would be a very long episode, and nobody has time for that, but ultimately, we’re using kind of a three-bucket quality framework. So, in that first bucket, we’re thinking about starting the program. That therapists are supported in how they begin to work with rehabilitation assistants. They always have the choice of if, when, and how they use a rehabilitation assistant in a treatment plan. And they’re supported in that by an optional but comprehensive internal certification program that we have here at Abilities to increase their competence and confidence. That is the foundation that we have to work from. And so that rehabilitation assistant certification, it’s not just a checklist, but it actually helps them to develop an internal coaching system. So therapists are trained in how to work with assistants as partners, not just as task-doers.

Secondly, we think about support, whether that support is remote in another clinic, remote meaning they might be working asynchronously with their assistants, or maybe they’re working with them side-by-side with an assistant. No matter what that support looks like, we are providing clear structure, policies, and procedures to help clinicians supervise from a distance, knowing that as we create systems that support remote supervision, those systems will also support in-clinic supervision as well.

And then thirdly, we think about transitions because the reality is clinicians are going to change over time. People are going to take maternity leave. They are going to go on vacation. They may even leave the organization as a whole. And so, we’ve systematically decided how we’re going to handle staff turnover with continuity and quality standards. And so, the result of this three-bucket quality framework is that there is much more consistency, stronger clinical outcomes, and better clinician well-being.

So, the reason that I’ve just noticed why this works is that when we use rehabilitation assistants in our treatment plan, we’re not just offloading tasks; we’re scaling care with integrity. So therapists feel more supported and less isolated. Clients receive more regular, consistent care, and rehabilitation assistants feel empowered and confident in the work that they’re doing. Most importantly, this model is much more financially accessible without sacrificing quality.

So, again, that may sound like we have perfected this. We definitely have been working hard on this for the last 17 years that Abilities has been around. But we are continuing to build on this model. So next up is our therapist partnership opportunities and clinical leadership development, using this as a foundation.

So my invitation is, if you’re a therapist that wants to be part of a team that’s innovating with heart, of course, we would love to hear from you. And if you’re in the therapy world and this has sparked some ideas with you, let’s keep this conversation going. Yes, of course, I am busy. We are all busy, but I am never too busy to connect with you. You can always feel free to connect with me at Heather@AbilitiesRehabilitation.com to take this conversation to the next level. I hope this has been thought-provoking for you, and I will talk to you next in the next episode. Take care.

Thanks for joining me this week on the Clinicians Creating Impact podcast. Want to learn more about the work I’m doing with Abilities Rehabilitation? Head on over to abilitiesrehabilitation.com. See you next week.