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					              NEEDS ASSESSMENT AND ANALYSIS OF
POTENTIAL STRATEGIES FOR A PHYSICAL THERAPY ASSISTANT PROGRAM
                          FOR ALASKA




                    Zuzana Rogers, PT, COMT
                           Consultant
                    Advanced Physical Therapy
                        Abbott Rd Ste 200
                      Anchorage, AK 99507




                          January 2011
                                      TABLE OF CONTENTS


1. Introduction ……………………………………………………………………………..3
2. PTA profession background…………………………………………………………...4
           What can’t a PTA do?.................................................................................6
           Practice settings………………………………………………………………...6
           Direct access issues…..……………………………………………...………..7
3. Practice requirements………………………………………………………………….7
4. Career outlook for physical therapist assistants…………………………………….8
       Supply and demand for physical therapist assistants in Alaska ……………..11
       The need for physical therapist assistant program in Alaska…………………11
       Rural areas…………………………………………………………………………13
5. Physical therapist assistant education………………………………………………14
       Pre-physical therapist assistant education requirements……………………..14
       Physical therapist assistant program overview…………………………………15
       Clinical experience………………………………………………………………..16
       Supervision of student physical therapy assistants……………………….......16
       Graduation requirement…………………………………………………………..17
       Continuing education and advancement……………………………………….19
6. Accreditation process………………………………………………………………...22
7. Steps towards Candidacy for Accreditation Status ……………………………….23
       Program development…………………………………………………………….24
       Submission of Application for Candidacy………………………………………24
       Application for Candidacy review/ Visit to the Program/ Candidacy Visit
       Report………………………………………………………………………………25
       Respond to Visit…………………………………………………………………..26
       CAPTE makes a candidacy decision…………………………………………...26
8. Accreditation requirements…………………………………………………….........26
9. Recommendations for a physical therapy assistant program at the University of
    Alaska………………………………………………………………………………….26
       Recommended program specifics………………………………………………27
           Degree offered………………………………………………………………..27
           Program length……………………………………………………………….27
           Program delivery……………………………………………………………..28
           Students enrolled…………………………………………………………….28
           Resources and facilities……………………………………………………..29
           Faculty…………………………………………………………………………30
           Clinical education…………………………………………………………….30
           Prerequisite coursework……………………………………………………..32
           Cost…………………………………………………………………………….33
10. Other avenues to explore…………………………………………………………..33
11. Recommendations…………………………………………………………………..34
12. Additional resources…………………………………………………………………35
13. Attachments…………………………………………………………………………..37




                                                     2
       The University of Alaska is considering the establishment of its own accredited

physical therapist assistant program, whose outcome would be Associate degree, which

is recognized state and nationwide. This report attempts to assess the need for physical

therapist assistant education in Alaska and necessary steps to implement it. The

information presented in this document was collected from, and it is based on a variety

of sources including American Physical Therapy Association, the Commission on

Accreditation of Educational Programs (CAPTE), Alaska State Chapter of APTA, survey

of physical therapists and physical therapist assistants in Alaska, personal

communications, and meetings.

     The University of Alaska has already committed itself to growth in the future as

described in the Strategic Plan. The proposed physical therapy program was seen as a

potential means to achieve this growth.




                                       Introduction



     When assessing the future need for a particular health profession in any given

geographical region, it is important to consider five distinct and variable elements:



   1. Is there currently a shortage of practitioners within the region? If so, what steps

       may be required to balance the market?

   2. What is the region’s anticipated future growth and how many practitioners will be

       required to meet this anticipated growth?




                                             3
   3. What are some of the anticipated changes in the profession’s scope of practice

       and new career options and how will these changes increase or decrease the

       future demand for practitioner services within the region being evaluated? Will

       future practitioners require new or different skill-sets than those of current

       practitioners, and if so, how will these requirements affect the available workforce

       within the region?

   4. What changes in technology will likely influence the productivity of physical

       therapy practitioners?

   5. Will the anticipated growth in the net number of practitioners keep pace with

       future needs for practitioners when one considers other growth variables? (e.g.,

       future graduation, retirement, and death rates; reciprocity into and away from the

       state and region; and practitioners leaving the profession).




                            PT/ PTA profession background



       Physical therapy is a healthcare profession dedicated to identifying the highest

functional potential of the individual client and striving to reach that goal through a

variety of means. Physical therapy is only provided by a licensed physical therapist (PT)

or a physical therapist assistant (PTA) under the supervision of a physical therapist. The

physical therapist performs a thorough interview, examination, and evaluation with the

patient and combines resulting findings with other health care information, such as

diagnostic test results, to determine a diagnosis and create a unique treatment plan.




                                              4
Physical therapists utilize a variety of treatments including, but not limited to, educating

the client or caregiver, therapeutic exercise, functional training in self-care, manual

therapy, orthotics and prosthetics, wound care and integumentary protection, physical,

mechanical, and electrical modalities, and work integration and reintegration.
      Physical

therapy can be beneficial to a wide range of clients, from the premature infant to the

aged, the well to the terminally ill. Physical therapists may choose to specialize in a

specific area such as cardiopulmonary, geriatrics, sports, clinical electrophysiology,

neurology, orthopaedics or pediatrics. To meet the needs of so many different types of

people, PTs and PTAs practice in a variety of settings including outpatient clinics,

fitness centers, hospitals, skilled nursing facilities, schools, patient homes, sports

teams, and work settings. They also practice in the community at health fairs or

community centers performing general fitness assessments or screening for fall and/or

injury risk. Additionally, PTs and PTAs may teach at universities or do research.

Physical therapy is a dynamic profession and an integral part of healthcare services in

the 21st century.

     Physical therapist assistants (PTAs) provide physical therapy services under the

direction and supervision of a physical therapist. PTAs help people of all ages who have

medical problems, or other health-related conditions that limit their ability to move and

perform functional activities in their daily lives. PTAs work in a variety of settings

including hospitals, private practices, outpatient clinics, home health, nursing homes,

schools, and sports facilities. PTAs must complete a 2-year associate's degree and are

licensed, certified, or registered in most states. Care provided by a PTA may include

teaching patients/clients exercise for mobility, strength and coordination, training for




                                              5
activities such as walking with crutches, canes, or walkers, massage, and the use of

physical agents and electrotherapy such as ultrasound and electrical stimulation.1



What can’t a PTA do?

          Primarily, physical therapy assistants cannot, under any circumstances, work

privately on their own. They must work with a physical therapist and assist with patient

care, not dictate it. There are also guidelines that vary from state-to-state regarding the

responsibilities of a PTA. The responsibilities and expectations of a PTA may also be

governed by their place of employment.



Practice settings

        Physical therapists and physical therapist assistants practice in various facilities.

The 2006 APTA Practice Profile survey instrument asked a series of questions that

described how respondents provided care (Table 1)2.



Facility       Musculoskeletal      Neuromuscular   Intergumentary     Cardiopulmonary
Acute care          44.0                 26.4             10.4               19.2
hospital
Subacute             30.4                56.7             3.2                 9.7
rehab
hospital
Hospital             73.4                20.9             3.4                 2.2
based
outpatient
facility
Private              82.6                14.8             1.4                 1.2
practice
SNF                  44.8                30.9             6.3                18.0
Home                 47.1                35.8             2.9                14.1
care

1Guide to Development of Educational Programs for Physical Therapists and Physical Therapist
Assistants. www.apta.org Accessed 12/01/2010.
2   www.apta.org/research. Accessed 11/23/10


                                                6
Table 1. Mean percentage of patient care time spent per week in each system



Direct access issues

          At present, there are 46 states (including Alaska) that provide patients direct

access to physical therapy services. This allows the physical therapist to evaluate and

treat patients without physician’s referral. Direct access laws vary from state to state,

with some states having more limitations than others. Full list of states that allow direct

access can be found on the American Physical Therapy Association website 3.

        The Alaska Physical Therapy Practice Act from 1986 uses following language

when summarizing direct access: “No Restrictions to Access. License revocation or

suspension when failure to refer a patient to another qualified professional when the

patient’s condition is beyond PT training”.

        This Practice Act is due for revision in 2014, and serious effort is exerted to

maintain and further define direct access. Any changes to the Practice Act might

influence Physical Therapist or Physical Therapist Assistant education.




                                      Practice requirements



           Requirement for physical therapist assistants to practice vary from state to

state. In order to provide physical therapy services, a physical therapist assistant in the

State of Alaska needs to meet following requirements:

      1. All 50 states and three additional jurisdictions require that physical therapist


3   www.apta.org/research. Accessed 11/23/10


                                                7
      assistants pass an accredited PTA education program consisting of classroom

      instruction and hands-on clinical experience. Alaska allows the use of online

      schools for students training to become a Physical Therapy Assistant.

   2. Passing of the National Physical Therapy Exam is a prerequisite for obtaining a

      license in all states as well. The Federation of State Boards of Physical Therapy

      (FSBPT) coordinates and administers all licensure examinations for potential

      PTAs. Proof that the exam has been passed will be required when applying for a

      physical therapy assistant license.

   3. Some states also require PTAs to pass a state jurisprudence exam covering laws

      and regulations in the state in which you are becoming licensed. These are

      primarily multiple choice exams administered by the state. In many cases, they

      are open-book or can be completed at home or online.

   4. Many states also require that physical therapy assistants complete training in

      CPR and First-Aid. A minimum number of clinical hours are also required in all

      states. Additionally, it is possible that background checks will be administered to

      PTA license applicants.




                   Career outlook for physical therapist assistants



     The nation’s aging population and expanded health care coverage will increase

the demand for physical therapist (PT) and physical therapist assistant (PTA). It is

projected that healthcare will add the most jobs during the 2008-2016 time period. The




                                            8
increased demand in this area stems largely from an aging population that will require

care at home, in nursing care facilities, and in inpatient and outpatient settings. The

large baby-boom generation is entering the prime age for heart attacks and strokes,

further increasing the demand for cardiac and physical rehabilitation. In addition, future

medical developments should permit an increased percentage of trauma victims to

survive, creating added demand for therapy services.

     Occupations that will "likely grow in importance" include physical therapists and

physical therapist assistants. In addition, the expected expansion of health care

coverage through reform measures could lead to increased demand for health care

professionals.

       Physical therapy assistants are among the highest paid individuals with just an

associate’s degree. After only two years of education, PTAs can enter the job field and

at entry level, depending on their geographic location and place of employment, earn as

much as $50,000.



       The median physical therapy assistant salary in the United States is $46,140.

Annual physical therapy assistant pay, according to the U.S. Bureau of Labor Statistics,

ranges from the lowest ten percent earning $28,580 or less to the highest earning PTAs

in the country earning over $63,830. Hourly pay can vary from $13 an hour all the way

up to $31 an hour. As with any job, the geographic location and the specific place of

employment are key factors in figuring salary.

       The highest paying states for physical therapy assistants are California

($55,730), Nevada ($54,070), Texas ($53,530), Florida ($50,270), and Tennessee




                                             9
($49,840). The top paying metropolitan areas for this occupation are all located in

California and Texas with annual mean wage topping out at $67,700 in Oxnard-

Thousand Oaks-Ventura, California.

      The top paying industries for this occupation are as follows, with the annual

mean wage and annual hourly wage included:


  Home Health Care Services - $56,460, $27.14

  Employment Services - $51,890, $24.95

  Nursing Care Facilities - $50,070, $24.07

  Individual and Family Services - $49,340, $24.72

  Vocational Rehabilitation Services - $48,610, $23.37

  General Medical and Surgical Hospitals - $45,190, $21.73

  Health Practitioner Offices - $44,800, $21.54

 Physician Offices - $43,170, $20.76



      The majority of physical therapy assistants work full-time. They receive benefits

comparable to other healthcare professionals including insurance, pension, vacation,

disability, and retirement. Bonuses may also be included in the salary package for some

PTAs. In addition, some industries of employment, such as hospitals may offer signing

bonuses or incentives.

      Popular job listing sites, such as indeed.com and salary.com currently list jobs for

physical therapy assistants with salaries that range from $34,000 to $80,000 for full-time

workers.

      Additional costs that may be associated with physical therapy assistants primarily



                                           10
will come from license renewal and continuing education. Most states require PTAs to

renew their license biennially and complete a specific number of continuing education

hours. State-to-state renewal requirements vary for physical therapy assistants.




Supply and demand for physical therapy practitioners in Alaska

         In 2009, there were 1,008 Licensed PTs in Alaska, of which 503 resided in the

state. Licensed PTs per 100,000 population was 144.31, while licensed PTs that reside

in the State per 100,000 population was 72.01. National average of PTs per 100,000

population was 58.434.

         Currently, there are 121 licensed PTAs in the State of Alaska, of which 60 reside

in the state5. Licensed PTAs per 100,000 population is 17.32, which is below nationwide

average of 26.61 PTAs per 100,000 population.



The need for a physical therapy assistant program in Alaska.

        Regarding Alaska Workforce Report from 2006, Alaska will experience a 36%

growth of physical therapist positions projected to 2012. With the growth of physical

therapy profession, the need for physical therapy assistants will grow as well. US

Department of Labor projects 32.4% growth of Physical Therapist Assistants though

2016. The vacancy rate in private practice identified by a 2010 survey performed by the

American Physical Therapy Association was found to be 14.4% among full-time PTAs,




4   www.apta.org, accessed 09/28/2010.
5   www.apta.org accessed 1/12/2011


                                             11
increase from 8.8% from 20086.

       Currently, there are no PTA programs in the State of Alaska. There are 6 PTA

programs in the state of Washington, of which one is private. There is one PTA program

in Montana, Oregon, and Idaho. Alaska students might chose one of these programs

due to proximity to their state, but may also enter more distant programs. However,

Alaska students often chose to enter different profession due to inability to study in-state

and due to cost of out-of-state education.

       A survey given in 2010 assessed the need for physical therapists and physical

therapist assistants in Alaska. The survey answered 67 members of the Alaska

Chapter of APTA. The average distribution of physical therapists per clinic was 4.44

PTs/ clinic, with average of 1 PTA per 2 clinics. Twenty four members (36.4%) indicated

vacancy for PTs/PTAs, of which 69% can be filled with PTAs. The survey also indicated

that 39.7% of respondents would hire a PTA graduate from Alaska–based PTA

program, 33.3% of respondents were not sure. Several respondents commented on the

need for PT/ PTA program in Alaska (Table 3).


Pro PT/PTA program in             Pro PTA Program                 Pro PT program
        Alaska
Support Alaska                 The need for                   Limit on who PTAs can
Communities                    “professional extenders”       treat (Tricare insurance
                               in physical therapy            does not allow it)
                               practice
Support rural areas            Respondents had                PTs might be better
                               difficulty hiring a PTA        suited for rural areas due
                                                              to supervision issues
Enroll Alaska Native       The demand for PTAs                There might be limited
students who will practice might increase with                number of clinical sites
in rural areas             increasing cost of                 available to for PTA


6American Physical Therapy Association. Physical Therapy Vacancy and Turnover Rates in
Outpatient Private Practice Facilities. Available at: www.apta.org/research. Accessed 07/27/2010


                                               12
                             healthcare                    students due to
                                                           supervision requirements
Increase diversity for
health careers in Alaska
In-state tuition

Table 3: AK Chapter of APTA survey results and comments, 2010




Rural areas

       The Alaska Center for Rural Health, in a November 2000 survey, identified

shortages of nurses, social workers, dentists, dental assistants, pharmacists, opticians,

speech pathologists, school psychologists, physical therapists, emergency medical

technicians, mental health counselors, medical transcriptionists, radiologists, respiratory

therapists, community health aides, and certified nursing assistants.

       Alaska Small Hospital Performance Improvement Network (ASHPIN, or Network)

emerged in 2003 to form a network of the smallest, most rural hospitals. Its mission is to

improve the clinical, operational, and financial performance of Alaska 's small rural

hospitals to ensure patient access to appropriate healthcare services. Six (6) of the 13

Network members are healthcare providers located in medically underserved (MUS)

communities serving medically underserved populations.

       It is important to note that of Alaska's 24 acute care hospitals, all but four of those

hospitals have fewer than 100 beds , and of those 20, only two have more than 50

beds. Therefore, 75%, or 18 of Alaska 's 24 hospitals qualify as HRSA Small Hospital

Improvement Project (SHIP) hospitals. The four relatively large non-military,

medical/surgical hospitals in Anchorage (3) and Fairbanks (1) serve as regional referral

facilities for providers from rural areas of the state, and all of Alaska's hospitals serve an


                                             13
area larger - often much larger - than the community in which they are physically

located.

       Impacting the quality of local care is the fact that many of the healthcare workers

hired to work in rural settings are not of people of color, or even of Alaska Native

descent. Attempts to increase the number and proportion of members of under-

represented racial and ethnic groups who are primary care providers are important,

because ethnically diverse workers are more likely to provide services in a culturally

appropriate manner, but these efforts have been largely unsuccessful in Alaska. For

example, Alaska Natives trained in healthcare professions often do not practice in areas

where health services are in short supply, or in areas with high percentages of under-

represented racial and ethnic populations7.

       An Allied Health Program, such as physical therapist or physical therapist

assistant program that would allow Alaskans to study while living in the home state,

might supply practitioners who are skilled in working with the underserved population.




                          Physical therapist assistant education


Pre-physical therapist assistant education requirements

       All physical therapy assistants (PTA) must complete a high school education or

GED program. High school level classes that will prove helpful in the physical therapy

field include Math, English, Anatomy, Physiology, and Psychology. After high school,



7Alaska Center for Rural Health. Alaska 's Allied Health Workforce: A Statewide Assessment.
University of Alaska Anchorage , March, 2001



                                               14
potential PTAs will need to apply to an accredited physical therapy assistant education

program. There are currently around 300 physical therapy assistant education programs

accredited by the American Physical Therapy Association’s Commission on

Accreditation in Physical Therapy Education.




Physical therapist assistant program overview

       Physical therapy assistant degree programs typically take two years or five

semesters to complete. An associate’s degree is issued upon the successful completion

of a PTA education program. Most states do require that physical therapy assistants

obtain an associates degree prior to filing for a PTA license. PTA education programs

are available at technical or community colleges and some four-year colleges and

universities.

       Physical Therapy Assistant Degrees are divided into academic coursework and

hands-on clinical experience. Some programs may require students to get certified in

CPR and complete a semester of coursework in anatomy and physiology before they

can begin their clinical field experience. Other first aid certifications may also be

required.


Academic coursework includes instruction in the following:


  Algebra and Mathematics

  Anatomy

  Biology

  Chemistry



                                             15
  English

  Kinesiology

  Neurological Concepts

  Orthopedics

  Pathology

  Pediatrics

  Psychology

  Physical Therapy Techniques

  Physiology




Clinical Experience

       Clinical experience is viewed as being absolutely essential to ensuring that

students understand the concepts they have covered in the classroom and can properly

perform their expected responsibilities. Most hand-on experience will take place in

treatment centers.



Supervision of student physical therapy assistants

     Student physical therapist assistants, when participating as part of a physical

therapist assistant education curriculum, and when acting in accordance with the

American Physical Therapy Association policy and applicable state laws and

regulations, are qualified to perform selected physical therapy interventions under the

direction and direct supervision of either the physical therapist alone or the physical




                                            16
therapist and physical therapist assistant. The physical therapist is responsible for

patient/client management. Direct supervision means the physical therapist is

physically present and immediately available for direction and supervision. The physical

therapist will have direct contact with the patient/client during each visit that is defined in

the Guide to Physical Therapist Practice. Telecommunications does not meet the

requirement of direct supervision 8

     As of 10/01/10, Medicare Part A and Part B implemented new therapy student

supervision guidelines in Skilled Nursing Facilities, which describes strictly 1:1, direct

line of sight supervision of the PTA student by PT/ PTA (Attachment 1).



Graduation requirements

       The completion of the degree also requires students to receive hands-on clinical

experience to fulfill the degree requirements. The clinical experience gives students the

first hand knowledge of the human anatomy and the basic physical therapist techniques

they will need in the medical field. Employers won’t often hire graduates unless they

have clinical experience.

       Upon completion of an accredited physical therapy assistant program, potential

PTAs will need to obtain a license, certification, or register in order to practice. License,

registration and certification requirements vary from state-to-state. However, most

states will require the completion of an accredited PTA education program, as covered

above, and the passing of the National Physical Therapy Exam. Some states also

require PTA candidates to pass a state jurisprudence examination.

8http://www.apta.org/
Supervision of Student Physical Therapy Assistants HOD P06-00-19-31
[Amended HOD 06-96-20-35; HOD 06-95-20-11] [Position] [Document updated: 12/14/2009]


                                              17
Overview of existing PTA programs which offer distance education9

                     Whatcom             GateWay             San Juan
                     Community           Community           College,
                     College, WA         College,            Farmington, NM
                                         Phoenix, AZ

Accredited           Yes, Northwest      Yes, Higher         Yes, Higher
                     Commission on       learning            learning
                     Colleges and        Commission of the   Commission of the
                     Universities        North Central       North Central
                                         Association of      Association of
                                         Colleges and        Colleges and
                                         Schools             Schools

Classification       Public rural,       Public Urban –      Public Rural -
                     serving Medium      serving             serving Large
                                         Multicampus

Degree offered       Associate in        Associate in        Associate in
                     Science             Applied Science     Applied Science

Program length       113 quarter hours   1. Full-time      2 years (6
                                         program           semesters) to
                                                           complete the
                                         2. Hybrid weekend program for
                                         program           distance
                                         incorporating     education
                                         distance          students. Format:
                                         education and on- online coursework
                                         campus weekend with on-campus
                                         courses. Can be   labs
                                         completed in 21
                                         months

Enrollment           24 students every   24/ year students   20 students every
                     fall/ 5,500 total   into full-time      admission cycle
                                         program; 20
                                         students every
                                         May into hybrid
                                         program,



9   www.apta.org accessed 11/13/10


                                          18
Admission            -Experience in the    -high school          -at least 5 hours of
requirements         field                 diploma or GED        experience in the
                     -2 quarters of lab-   -40 hours of          field
                     based courses in      experience in the     -Human Body
                     Anatomy and           field                 Structure and
                     Physiology            -college level        Function course (4
                     -lab-based            English               cr)
                     chemistry, biology,   -college-level        -Musculoskeletal
                     or physics            anatomy and           Focus for PTAs
                     -English 101          physiology            (3cr)
                     (Composition I)       -min GPA 2.4          -higher-level math
                     -college level                              -English
                     math                                        composition
                     -general                                    -min 2.5 GPA
                     psychology
                     (GERs are
                     automatically met
                     if completed
                     bachelor’s degree)
                     -min GPA of 2.5

Average tuition      In state: $1,920/     Resident: $71/        Resident:
cost                 year                  credit hour           $43/credit hour;
                     Out-of-state:
                     $6,750/ year with     Non-resident: not     Non-resident:
                     possibility of a      known                 $97/credit hour
                     waiver
Clinical             Two part time,        Three full-time 6     One 4-week
experience           Two 7-week full       week experiences      externship, Two 7-
                     time                                        week externships,

Faculty              One full-time, 4      Three full-time,      Five full-time, 2
                     part-time. Faculty    several adjunct       adjunct faculty.
                     to student ratio      faculty. Faculty to   Faculty to student
                     1:24                  student ratio 1;12    ratio 1:10
                                           in labs, 1;2 in
                                           lecture classes




Continuing education and advancement

      The license of a physical therapy assistant will need to be renewed on a regular

basis. Most states issue a two-year license. Certifications and registrations may also



                                            19
need to be renewed. In addition, continuing education might be required in order for

physical therapist assistants to maintain licensure. Continuing education most often

takes the form of online courses, college courses, seminars and conferences. The

American Physical Therapy Association is a great resource for exploring continuing

education options.

       Physical therapy assistants who wish to gain further knowledge in their field can

obtain additional skills in geriatric, pediatric, musculoskeletal, neuromuscular,

integumentary, and cardiopulmonary physical therapy. The American Physical Therapy

Associations gives recognition to such PTAs.

       There is minimal room for advancement as a physical therapy assistant. One

option might be advanced training and certification in geriatrics, pediatrics,

musculoskeletal, neuromuscular, integumentary, and cardiopulmonary physical therapy.

Other PTA’s, with years of experience, may advance into non-clinical areas like

administrative or academic teaching positions.



       Becoming a physical therapy assistant is not a stepping stone to becoming a

physical therapist. While there are a few “bridge” programs that allow PTAs to work

while going to school on weekends to become a physical therapist, they are rare. Such

programs will award a Master’s degree in Physical Therapy upon completion. However,

courses completed in a PT program are on the graduate level, while PTA courses are

on the undergraduate level, so they don’t meet the graduate degree requirements of

most physical therapy courses. Due to the intense study of physical therapy assistant

programs in such a short time frame, there simply is just not enough time for the




                                             20
prerequisites to be met that allows PTAs to go directly on to PT educational programs.

        Through campus based and online programs, aspiring Physical Therapy

Assistants in Anchorage, Fairbanks, Juneau and Sitka, Alaska may be able to prepare

themselves for the possibility of employment in some of the largest hospitals and

healthcare facilities in the state including Providence Alaska Medical Center, Fairbanks

Memorial Hospital, Alaska Regional Hospital, and Central Peninsula Regional Hospital.



Current situation regarding physical therapist and physical therapist assistant
education nationwide

                        Accredited           Developing               Totals
PT: US Programs        200 institutions     15 institutions       215 institutions
                       supporting 213       developing 15           supporting/
                         programs             programs            developing 228
                                                                     programs
                        MS/ MPT: 7           MS/ MPT: 0            MS/ MPT: 7
                         programs             programs               programs

                         DPT: 206         DPT: 15 programs      DPT: 221 programs
                         programs
     PT: Non-US         3 institutions           N/A                3 institutions
      Program           supporting 3                                supporting 3
                         programs                                    programs

                         Canada: 2                                   Canada: 2
                      International: 1                            International: 1
       PTA: US        244 Institutions      52 institutions       296 institutions
      Programs        supporting 263        developing 52           supporting/
                         programs             programs            developing 315
                                                                     programs
     PTA: Non-US       479 accredited       67 developing               546
      Programs           programs             programs         accredited/developing
                                                                     programs

Table 3: Number of PT and PTA programs as of December 13, 201010

10

http://www.apta.org/AM/Template.cfm?Section=PT_Programs3&TEMPLATE=/CM/Conte
ntDisplay.cfm&CONTENTID=45221


                                           21
Accreditation process through CAPTE



     The Commission on Accreditation in Physical Therapy Education (CAPTE) is the

only recognized agency in the United States for accrediting education programs for the

preparation of physical therapists and physical therapist assistants. CAPTE grants

specialized accreditation status to qualified entry-level education programs for physical

therapists and physical therapist assistants. Accreditation is a process used in the US to

assure the quality of the education that students receive. It is a voluntary, non-

governmental, peer-review process that occurs on a regular basis. CAPTE is appointed

by the Board of Directors of the American Physical Therapy Association; however, it

makes autonomous decisions concerning the Evaluative Criteria, its Rules and

Procedures, and the accreditation status of education programs for the preparation of

physical therapists and physical therapist assistants. The 30 members of the

Commission represent the communities of interest, including physical therapy and

physical therapist assistant educators, clinicians, consumers, employers,

representatives of institutions of higher education, and the public. 11



       Robin Wahto attended CAPTE accreditation workshop in San Antonio, TX (Sept

2010). Please see lecture notes for complete detail. A summary of the accreditation

process is provided below.


11Guide to Development of Educational Programs for Physical Therapists and Physical Therapist
Assistants. www.apta.org Accessed 12/01/2010.


                                              22
     The accreditation process through CAPTE consists of two steps:

   1. Application for Candidacy and achievement of Candidacy status

          The granting of Candidate for Accreditation status must occur prior to

       enrollment of students in the professional/technical phase of the physical

       therapist assistant program.

   2. Accreditation




       STEPS TOWARDS CANDIDACY FOR ACCREDITATION STATUS



1. Program director and supporting staff

1A. Employ a Program Director

       The program director should be employed full time 6-9 months prior to planned

date for submission of AFC (Application for Candidacy), to develop the program. The

program director for a PTA program should have following qualifications: PT or a PTA

with minimum of Master’s degree, licensure or certificate in the state, experience in

higher education (didactic/ teaching), experience in clinical practice, experience in

administration, experience in curriculum design, development, implementation, and

evaluation, and minimum of 5 years physical therapy experience. The program director

must be working for the institution on a full-time basis to develop the program. The

Program Director and at least one higher administrator from the institution must attend a

workshop to learn about the candidacy process. This must be done prior to the




                                            23
Application for Candidacy. Three workshops are conducted by the Department of

Accreditation staff annually in February, June/July, and October.



1B. Notify CAPTE

   CAPTE needs to be notified of new program development when Program Director is

hired (the notification letter should be official with PD’s CV attached). CAPTE then will

add the program to the list of developing programs and will allow the PD access to

electronic Portal.



1C. Employ an ACCE/ DCE

       Clinical education makes up approximately 1/3 of the curriculum. CAPTE does

not require this step but strongly recommends it. The program director and clinical

Coordinator then should work together to develop the program.



2. Program Development

2A. Selection of timing cycle.

                             Cycle A         Cycle B       Cycle C      Cycle D
Application for Candidacy    March 1         June 1        Sept 1       Dec 1
and fee due
Staff determination that     March 10        June 10       Sept 10      Dec 10
AFC is bona fide
AFC sent to Candidacy        March 15        June 15       Sept 15      Dec 15
reviewer
Candidacy visits between     April 15-30     July 16-31    Oct 16-31    Jan 16-31
Report of Candidacy Visit    May 15          August 15     Nov 15       Feb 15
to program
Response to Report of        June 15         Sept 15       Dec 15       March 15
Candidacy Visit due
CAPTE decision               Late July       Late Oct      Late Jan     Late April



                                            24
It is estimated that it takes 4-5 months after AFC submission before the program can be

implemented. Timing is crucial.



2B. Program development

      Mission, goals

      Expected outcomes

      Policies, procedures, and practices

      Curriculum

      Resources

      Clinical education program

      All other aspects of the program



2C. Write the Application for Candidacy

       The Application for Candidacy is a report through which institution provides

information about the institution’s plans for development and implementation of the

proposed program, such that it will meet the Evaluative Criteria for accreditation.



3. Submission of Application for Candidacy

       The AFC must be submitted on or before Mar 1, Jun 1, Sep 1, Dec 1.



4. AFC review by Candidacy Reviewer/ Visit to the program/ Candidacy Visit

Report




                                             25
         When the Application for Candidacy is considered bona fide by the reviewers and

is complete, the Candidacy Reviewer conducts a two-day visit to the program.



5. Respond to visit report

         Due 30 days after receipt of report, approximately 5 weeks prior to CAPTE

review



6. CAPTE makes a candidacy decision

         Upon CAPTE’s determination to grant a program Candidate for Accreditation

Status, students may be enrolled/ matriculated into the program’s first

professional/technical courses.




                            ACCREDITATION REQUIREMENTS


   1. Full complement of core faculty

   2. Complete curriculum, implemented

   3. All necessary space and equipment

   4. All needed clinical education placement




Recommendations for a Physical Therapist Program at the University of Alaska



         The University of Alaska is well-suited for a physical therapist assistant program.




                                              26
The mission of the University of Alaska Anchorage is “to discover and disseminate

knowledge through teaching, research, engagement, and creative expression. Located

in Anchorage and on community campuses in Southcentral Alaska, UAA is committed

to serving the higher education needs of the state, its communities, and its diverse

peoples. 
 The University of Alaska Anchorage is an open access university with

academic programs leading to occupational endorsements; undergraduate and

graduate certificates; and associate, baccalaureate, and graduate degrees in a rich,

diverse, and inclusive environment.”12

         The potential PTA program should be an integral part of the University. Allied

Health programs are designed to prepare graduates for work in rewarding careers in

Alaska’s rapidly growing health care industry. Each program provides experiential

education with students working alongside health professionals in real-work situations.

         The current and well-designed Allied Health Sciences Division is part of the

Community and Technical College at UAA and should support a PTA program.




Recommended Program Specifics



Degree offered:

Associate in Science or Associate in Applied Science

Program length:

5 semesters (CAPTE requirements)




12   http://www.uaa.alaska.edu/chancellor/uaa-mission-statement.cfm Accessed 1/20/2010


                                             27
Program delivery

     The two curricular format options that are utilized are an integrated, 2-year format

or a 1+1 format, where the general education courses are taught in the first year and the

technical PTA courses are offered in the second year. Admission requirements may

vary depending on the format selected. A hybrid program with didactic courses in pure

online delivery and procedural courses with online delivery of didactic material and face

to face delivery of hands-on materials and skills seems to be the most suited for Alaska.

Students would meet on regular basis for lab instructions and practice. All practical skills

would be taught, practiced, and tested during these lab sessions, as well as all written

exams would be completed during these lab sessions.

     Accreditation standards require distant delivery strategies to achieve equivalent

curricular outcomes and all delivery models require students to complete the same

curriculum and learning strategies - laboratories, small group discussions, and

experiential education programs - regardless of their physical location. The major

differences between the models are the degree to which students are required to be

independent learners and the amount of direct engagement between faculty and

students.



Students enrolled:

       8-10 students enrolled in the program (based on conversation with Jan Harris

and Robin Wahto). This number of students should be able to meet the workforce need

in the State of Alaska. Based on Vacancy data described earlier, the clinical community




                                            28
will be able to absorb the number of graduates expected (8-10 graduating PTA students

per 2 year period).



Resources and Facilities

     Significant resources are needed to develop and implement a PT or PTA

education program. This includes, but is not limited to:

1. Financial resources for

     Renovations of existing facilities or for new facilities

     Appropriate student services.

     Faculty recruitment

     Faculty salaries that may need to be competitive with the clinical salaries

     Faculty development

     Equipment and supplies

     Travel (clinical education; professional development)

     Library and learning resources



2. Space/Facilities

    Appropriate student services.

    Classrooms that will accommodate planned class size

    Laboratory space that accommodates needed treatment tables and physical

       therapy equipment for planned class size; laboratory space will need appropriate

       water and electrical access that will meet the needs of lab activities. Lab space

       is typically dedicated space. The students will need access to this lab outside of



                                              29
       class time for additional practice.

    Storage: of laboratory equipment and supplies

    Offices: space that ensures confidentiality

    Space for dressing/locker room space, computer labs, student gatherings



Faculty:

     Recruiting a qualified director is typically a difficult task due to the ongoing

shortage of qualified program directors for both PT and PTA programs. A program

director with expertise in curriculum development, accreditation requirements and

academic administration is vital to the success of a new program. Two full time faculty

members are required, including a full-time program director (hired 6-9 months prior to

application for candidacy), and adjunct faculty as needed. One of the full-time faculty

must be a PT (per CAPTE). Because there is also a shortage of qualified faculty,

recruiting qualified core (physical therapy educators) faculty will need to occur early

during program development and could also impact the timeline for starting the

program.




Clinical Education


     Both PT and PTA programs must have sufficient numbers and varieties of clinical

sites to ensure that students achieve expected program outcomes. It is important to

have an abundance of available clinical education sites as staff shortages and

competition from other physical therapy education programs may limit the number and



                                             30
quality of available clinical experiences. The accreditation criteria require that the

number of clinical sites be 125% of the number of students seeking those sites. That

would result in the necessity of 10-13 clinical sites. Based on personal communication

with practicing physical therapists and clinic owners/ directors, there seems to be

sufficient number of clinics that would be available for clinical education in the

Anchorage and Mat-Su area. The potential availability of physical therapy clinics in

Fairbanks, Kenai Peninsula, and Southeast is unknown.

     Because developing the clinical education component of the curriculum is a time

consuming activity, the Director of Clinical Education/Academic Coordinator of Clinical

Education (DCE/ACCE) is often the second person to be hired.

      Curriculum development in physical therapy education requires careful

coordination of the classroom/laboratory and clinical components. Clinical education

sites must be recruited and developed to provide the appropriate clinical experiences for

the level of student preparation.

     Qualified clinical instructors are essential to ensure sufficient clinical mentoring

and teaching. Clinical education experiences are typically completed at clinical sites in

the immediate geographic area for PTA programs. Sufficient time, personnel and

budget will be needed to obtain and develop clinical education sites that will meet the

needs of the program related to program and institutional mission, curricular

expectations, curricular format, and planned class size.



Prerequisite coursework




                                             31
Current University of Alaska coursework that might satisfy admission requirement to a

PTA program:


Category                    UA course

Written Communication       ENGL 111 Methods of written communication
Skills

Quantitative Skills         MATH 107 College Algebra

                            MATH 108 Trigonometry

Human Anatomy and           BIOL111 Human Anatomy and Physiology I
Physiology with lab
                            BIOL 112 Human Anatomy and Physiology II

Natural Sciences            BIOL A102 Introductory Biology

(Lab – based Biology,       Optional BIOL A103 Introductory Biology Lab
Chemistry, or Physics)
                            CHEM A105/L General Chemistry I

                            CHEM A106/L General Chemistry II

                            PHYS A123/L Basic Physics I

                            PHYS A124/L Basic Physics II



Sociology                   SOC 101 Introduction to Sociology

Psychology                  PSY 111 General psychology

                            PSY 150 Lifespan Development


Note:

If the University of Alaska decides to address rural population, the mission of the

program needs to reflect it. Also, might consider adding Alaska History / Culture to the

program prerequisites or core curriculum.




                                            32
Cost

       The costs for the Alaska student to complete an in-state program would be

significantly less expensive as compared to relocating out-of-state to study.




                                 Other avenues to explore



Partnership with already existing PTA programs

       The partnership model for physical therapy assistant education is one viable option

for the University of Alaska; it would provide the opportunity for Alaska residents to

receive a physical therapy assistant education and generate a meaningful increase in

PTA manpower for the state. Although there are no sources of data to determine the

number of students who studied out-of-state and then returned to practice in Alaska, the

general consensus is that students tend to locate close to where they complete their

education and thus don’t return to Alaska. If this tenet is true, then it is logical that

conducting— at a minimum—the last semester of full-time experiential education in

Alaska will increase the likelihood that Alaska residents who study physical therapy will

be more likely to remain in the state to practice.

       If UA were to partner with an existing accredited physical therapist assistant

program experienced in satellite program delivery, a satellite campus delivery model for

local access to PTA education could provide Alaska residents with an opportunity to

remain in Alaska to complete their entire PTA degree.




                                              33
                                   RECOMMENDATIONS

    1. Organize an Advisory board consisting of:

              a. UAA representative (budget, timeline, organization, academic affairs,

                 etc)

              b. PT/ PTA with experience in higher PT/ PTA education (prerequisites,

                 curriculum, student selection process, student advisor)

              c. PT/ PTA with experience in clinical placement and equipment issues

                 (developing clinical rotation sites, sequencing, contracts with clinical

                 sites)

              d. Accreditation consultant


      Consultant services are strongly advised for institutions considering developing a

new physical therapy education program for guidance in program planning,

development, and implementation, including program assessment. Consultants that are

experienced physical therapy educators can facilitate discussions about whether or not

to proceed with program development. Should the decision be made to move forward,

consultants may be beneficial to guide program development or to provide expertise in

a specific area of program development; for example, curriculum development, faculty

development or outcomes assessment.

A list of educational consultants may be obtained by contacting Jody Gandy, Director,
                                                                                    13
Department of Academic/Clinical Education Affairs at jodygandy@apta.org.




13 13 Guide to Development of Educational Programs for Physical Therapists and Physical Therapist
Assistants. www.apta.org Accessed 01/10/2011.


                                               34
Additional Resources:



Administrators of established education programs for the preparation of physical

therapists and physical therapist assistants: Personnel from the institution

considering the establishment of a program may find it helpful to visit other programs

from similar academic institutions to gather information on space, staffing, equipment,

and other resources. The director of an existing program may be willing to share

information on essential resources and costs. However, since a new program may be in

competition with an existing program for students, faculty and clinical education sites,

program directors may be limited in the amount or type of assistance they can provide.



Physical therapists and physical therapist assistants employed in varied practice

settings within the community: Physical therapists in the community may be able to

assist in the assessment of the availability and accessibility of local clinical education

sites and the potential for positions in the local area for graduates of the proposed

program. These individuals may be good sources for members of a program advisory

committee.



Advisory Committee: Advisory committees typically include representatives from

stakeholder groups from within and outside the college. In addition to the clinicians,

advisory committees often include leaders in the health care community, other health

care professionals, health care administrators, future employers, and consumers.

Representatives from within the college may include faculty and administrators of the




                                             35
basic sciences and other health care professions, admissions officials, student services

personnel, and the deans of appropriate colleges.




                                           36
ATTACHEMENTS


Implementing MDS 3.0: Use of Therapy Students
As facilities continue to change their current practices to implement the Minimum Data
Set Version 3.0 (better known as MDS 3.0), one of the emerging issues is the manner in
which they document and utilize therapy students. Under the new rules, in order to
record the minutes as individual therapy when a therapy student is involved in the
treatment of a resident, only one resident can be treated by the therapy student and the
supervising therapist or assistant (for Medicare Part A and Part B). In addition, the
supervising therapist or assistant cannot engage in any other activity or treatment when
the resident is receiving treatment under
Medicare Part B. However, for those residents whose stay is covered under Medicare
Part A, the supervising therapist or assistant cannot be treating or supervising other
individuals and the therapist or assistant must be able to immediately intervene or assist
the student as needed while the student and resident are both within line of sight
supervision. For example under Part A, the therapist or assistant could be attending to
paperwork while supervising the student and resident.

Under Medicare Part A, when a therapy student is involved with the treatment, and one
of the following occurs, the minutes may be coded as concurrent therapy:
• The therapy student is treating one resident and the supervising therapist or assistant
is treating another resident and the therapy student and the resident the student is
treating are in line of sight of the supervising therapist or assistant; or
• The therapy student is treating two residents, both of whom are in line of sight of the
therapy student and the supervising therapist or assistant, and the therapist is not
treating any residents and not supervising other individuals; or
• The therapy student is not treating any residents and the supervising therapist or
assistant is treating two residents at the same time, regardless of payer source, both of
whom are in line of sight.

The student would be precluded from treating the resident and recording the minutes as
concurrent therapy under Medicare Part B.

Under Medicare Part A, when a therapy student is involved with group therapy
treatment, and one of the following occurs, the minutes may be coded as group therapy:
• The therapy student is providing the group treatment and all the residents participating
in the group and the therapy student are in line of sight of the supervising therapist or
assistant who is not treating any residents and is not supervising other individuals
(students or residents); or
• The supervising therapist/assistant is providing the group treatment and the therapy
student is not providing treatment to any resident.




                                           37
Under Medicare Part B, when a therapy student is involved with group therapy
treatment, and one of the following occurs, the minutes may be coded as group therapy:
• The therapy student is providing group treatment and the supervising therapist or
assistant is present and in the room and is not engaged in any other activity or
treatment; or
• The supervising therapist or assistant is providing group treatment and the therapy
student is not providing treatment to any resident.

These changes as well as other changes regarding MDS 3.0 took effect October 1,
2010. If you have questions regarding this provision or other provisions within MDS 3.0,
please contact the APTA at advocacy@apta.org or at 888.999.2782 ext. 8533.




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